Histopathologic Changes After Bipolar Resection of the Prostate: Depth of Penetration of Bipolar Thermal Injury
Histopathologic Changes After Bipolar Resection of the Prostate: Depth of Penetration of Bipolar Thermal Injury
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DOI：
10.1089/end.2012.0202
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发表时间：
2012-10-01
影响因子：
2.7
通讯作者：
Haleblian, George
中科院分区：
文献类型：
--
作者：
Maddox, Michael;Pareek, Gyan;Haleblian, George
背景和目的：虽然启动双极汽化所需的功率高于传统单极切除术，但维持双极汽化所需的能量明显较低，可能导致较少的热组织损伤。这可能对止血、瘢痕形成和围手术期发病率有影响。本研究的目的是评估前列腺组织的组织病理学变化后，双极经尿道前列腺汽化术的prostate.Patients和方法：男性患者年龄大于40岁，诊断为良性前列腺增生症（BPH）谁选择接受双极经尿道前列腺汽化术被列入本研究。如果患者既往接受过经尿道前列腺切除术（TURP）或前列腺放射治疗，则将其排除。使用Olympus按钮汽化电极汽化前列腺组织。然后使用环形电极获得深部切除标本。汽化和循环切除表面着墨，并发送病理分析，以确定存在的总组织学变化和双极汽化current.Results的渗透深度：共12名男子进行了双极TURP在标准设置的290 W切割和145 W凝固电流。患者平均年龄为70 - 10.2岁（范围56-88岁）。平均手术时间为48.7 ± 20.2分钟（范围30-89分钟）。平均热损伤深度为2.4 ± 0.84 mm（范围0.3-3.5 mm）。组织学评价表明，在所有标本中的热损伤，但没有总的碳encountered.Conclusions：在双极系统，切除发生在低得多的峰值电压和温度相比，单极系统。从理论上讲，这导致较少的附带热损伤和组织烧焦。我们的组织研究表明，纽扣式汽化电极的穿透深度远大于先前的双极TURP研究。这可能是因为热损伤代表了一个渐进的连续的组织学变化。
Background and Purpose: While the power needed to initiate bipolar vaporization is higher than conventional monopolar resection, the energy needed to maintain bipolar vaporization is significantly lower and may result in less thermal tissue injury. This may have implications for hemostasis, scarring, and perioperative morbidity. The objective of this study is to assess histopathologic changes in prostatic tissue after bipolar transurethral vaporization of the prostate.Patients and Methods: Male patients older than 40 years with a diagnosis of benign prostatic hyperplasia (BPH) who elected to undergo bipolar transurethral vaporization of the prostate were included in this study. Patients were excluded if they had a previous transurethral resection of the prostate (TURP) or prostate radiation therapy. An Olympus button vaporization electrode was used to vaporize prostate tissue. A loop electrode was then used to obtain a deep resection specimen. The vaporized and loop resection surfaces were inked and sent for pathologic analysis to determine the presence of gross histologic changes and the depth of penetration of the bipolar vaporization current.Results: A total of 12 men underwent bipolar TURP at standard settings of 290 W cutting and 145 W coagulation current. Mean patient age was 70 -10.2 years (range 56-88 years). Mean surgical time was 48.7 +/- 20.2 minutes (range 30-89 min). Mean depth of thermal injury was 2.4 +/- 0.84mm (range 0.3-3.5 mm). Histopathologic evaluation demonstrated thermal injury in all specimens, but no gross char was encountered.Conclusions: In bipolar systems, resection takes place at much lower peak voltages and temperatures compared with monopolar systems. Theoretically, this leads to less collateral thermal damage and tissue char. Our tissue study illustrates that the button vaporization electrode achieves a much larger depth of penetration than previous studies of bipolar TURP. This may be because thermal injury represents a gradual continuum of histologic changes.