Bóc nhân tuyến tiền liệt qua niệu đạo sử dụng Laser Thulium: Kỹ thuật En-Bloc và kết quả=En-Bloc Thulium Laser enucleation of the prostate: Technique and preliminary results in a single center

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Việt Cường Nguyễn, Hoài Nam Trần, Văn Hinh Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.96-105

Bộ sưu tập: Metadata

ID: 242463

Thêm vào giỏ

Chia sẻ kinh nghiệm thực hiện kỹ thuật và kết quả đạt được trong phẫu thuật En- Bloc ThuLEP. Đối tượng và phương pháp: Bệnh nhân tăng sinh lành tính tuyến tiền liệt (TSLTTTL) có có chỉ định phẫu thuật, được phẫu thuật ThuLEP theo kỹ thuật En-Bloc (En-Bloc ThuLEP) tại khoa ngoại Tiết niệu - Bệnh viện Quân Y 175. Nghiên cứu tiến cứu, mô tả cắt ngang, theo dõi dọc, không đối chứng. Phẫu thuật En-Bloc ThuLEP sử dụng dụng cụ nội soi bóc nhân qua niệu đạo 26Fr, tay cắt ngược, năng lượng Laser Thulium bước sóng liên tục 2013 μm, dây dẫn tia Laser 800 μm, kỹ thuật En-Bloc bóc toàn bộ tuyến tiền liệt thành 1 khối, tuyến tiền liệt bóc ra được đẩy vào bàng quang và được xay nhỏ hút ra ngoài bằng máy xay mô (Morcellator). Đánh giá kết quả liên quan kỹ thuật qua các yếu tố trong phẫu thuật, tai biến trong phẫu thuật, biến chứng sau phẫu thuật. Đánh giá hiệu quả bóc nhân với thể tích tuyến tiền liệt còn lại, thể tích tuyến tiền liệt đã bóc ra, kết quả điều trị theo tiêu chuẩn của Homma Y. (1996). Kết quả: 79 bệnh nhân TSLTTTL được phẫu thuật En-Bloc ThuLEP từ tháng 09/2023 đến tháng 06/2024. Tuổi trung bình 69,32 ± 7,12 tuổi. Thể tích tuyến tiền liệt trung bình 66,87 ± 32,83 ml. 100% bệnh nhân được thực hiện phẫu thuật thành công theo kỹ thuật En-Bloc ThuLEP, không có trường hợp nào phải dừng cuộc phẫu thuật giữa chừng, không có trường hợp nào phải chuyển phương pháp phẫu thuật. Thời gian phẫu thuật trung bình 81,77 ± 35,63 phút, thời gian bóc nhân 53,67 ± 23,96 phút, thời gian xay mô 11,20 ± 6,36 phút. Lượng máu mất trong phẫu thuật với giảm hồng cầu 0,35 ± 0,38 T/l, giảm huyết sắc tố 1,09 ± 1,13 g/dl. Không có trường hợp nào tử vong, 1 trường hợp chảy máu phải truyền máu sau phẫu thuật, 1 trường hợp thủng vỏ tuyến tiền liệt, 1 trường hợp xay vào niêm mạc bàng quang, 1 trường hợp nhiễm khuẩn niệu sau phẫu thuật, 2 trường hợp bí tiểu sau rút thông. Tỷ lệ tuyến tiền liệt còn lại trung bình là 24,24 ± 10,77 ml, kết quả phẫu thuật về mặt giải phẫu theo tiêu chuẩn Homma Y. có 73,97% kết quả tốt, 20,55 kết quả khá, 5,48% kết quả trung bình, không có trường hợp nào kết quả kém, 100% đạt hiệu quả rất tốt về chất lượng cuộc sống. Kết luận: Kỹ thuật En-Bloc ThuLEP là kỹ thuật an toàn, hiệu quả.Transurethral Thulium Laser enucleation of the prostate (ThuLEP) using the En-Bloc technique has been evaluated and described by many authors worldwide for its advantages. However, its application in Vietnam remains limited. This report aims to share the experiences and results achieved in performing the En-Bloc ThuLEP technique. Patients and methods: Patients with benign prostatic hyperplasia (BPH) indicated for surgery underwent En-Bloc ThuLEP at the Urology Department of 175 Military Hospital. The study is prospective, descriptive, cross-sectional, longitudinal, and non-comparative. The En-Bloc ThuLEP procedure utilized a 26Fr transurethral enucleation endoscope, reverse cutting handpiece, continuous wave 2013 μm Thulium Laser energy, and 800 μm laser fiber. The En- Bloc technique involves enucleating the entire prostate as a single mass, pushing it into the bladder, and morcellating it with a morcellator for removal. Outcomes were evaluated based on intraoperative technical factors, intraoperative and postoperative complications. The effectiveness of enucleation was assessed by the remaining prostate volume, enucleated prostate volume, and treatment outcomes according to Homma Y. (1996). Results: Seventy-nine BPH patients underwent En-Bloc ThuLEP from September 2023 to June 2024. The average age was 69.32 ± 7.12 years, and the average prostate volume was 66.87 ± 32.83 ml. The En-Bloc ThuLEP technique was successfully performed in 100% of patients, with no cases requiring termination or conversion to another surgical method. The average surgery time was 81.77 ± 35.63 minutes, enucleation time was 53.67 ± 23.96 minutes, and morcellation time was 11.20 ± 6.36 minutes. Blood loss during surgery resulted in a reduction of red blood cells by 0.35 ± 0.38 T/l and hemoglobin drop by 1.09 ± 1.13 g/dl. There were no deaths, but there was one case of postoperative bleeding requiring a transfusion, one case of prostate capsule perforation, one case of morcellator injury to the bladder mucosa, one case of postoperative urinary infection, and two cases of urinary retention after catheter removal. The average remaining prostate volume was 24.24 ± 10.77 ml. According to Homma Y.'s anatomical outcome criteria, 73.97% had excellent results, 20.55% had good results, and 5.48% had fair results, with no poor results. All patients achieved excellent quality of life improvements. Conclusion: The En-Bloc ThuLEP technique is safe and effective.

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