屏基泌尿科引進雷射手術，泌尿道結石、攝護腺肥大患者新選擇
2021-12-29 17:35 記者林豊雅/屏東報導
▲屏東基督教醫院泌尿科兩位新生代醫師引進雷射手術，提供屏東地區泌尿道結石及攝護腺肥大患者更多醫療選擇。
順應醫療技術進步，屏東基督教醫院泌尿科兩位新生代醫師引進雷射手術，提供屏東地區泌尿道結石及攝護腺肥大患者更多醫療選擇。
根據內政部統計109年國人的平均壽命為81.3歲，其中男性78.1歲、女性84.7歲，再創新高，國人越來越長壽，有些避不掉的老化疾病便越來越多人困擾。俗稱攝護腺肥大的前列腺良性增生，便是其一。
攝護腺位於男性膀胱頸下方、尿道上方，一般來說攝護腺良性增生早在40歲就已經開始，51及60歲時發生率約有50%，70歲以上男性60％有攝護腺肥大的疾病。良性攝護腺肥大是男性衰老的正常生理過程，只是攝護腺不斷肥大便會堵塞尿道，漸漸會出現尿不出來、頻尿、夜尿、尿失禁等窘況，影響生活品質，有些人不好意思就醫，誤以為是膀胱無力還去買○○膀胱丸，直到無法排尿才到泌尿科求診。
在藥物治療無法有效改善症狀時，手術治療成為必要選項。屏基泌尿科主治醫師錢家陞表示，相較於傳統電刀刮除手術有刮除不全、容易復發、出血量難控制的缺點，運用雷射剝離剜除手術，把增生組織和攝護腺外圍分開，可以分成一整塊或兩三瓣完整的剜除下來，不僅出血量少，恢復也快，減少手術和麻醉的風險，術後導尿管放置時間及住院天數也縮短；也因為增生組織完整剝除，復發機率相當低。
▲屏東基督教醫院泌尿科兩位新生代醫師引進雷射手術，提供屏東地區泌尿道結石及攝護腺肥大患者更多醫療選擇。圖_屏東基督教醫院提供
一名65歲王先生，被小便無力及頻尿的現象困擾多年，服用藥物仍改善有限，這次因為急性尿滯留(尿不出來)到急診，導尿後，多次移除尿管仍無法自行解尿，因此接受雷射剝離剜除手術，將攝護腺增生組織完整刨除後，症狀迅速獲得改善，術後檢查最大尿流速每秒可達32.8cc；攝護腺特殊抗原指數 (PSA)也從術前的11.2ng/ml降到1.1ng/ml(標準值為4)且攝護腺重量從100公克減為21公克(攝護腺正常重量20公克)。上廁所時再也不會站很久還尿不出來，晚上也能一覺到天亮。
台灣地區泌尿道結石盛行率約為10﹪，且五年內的復發率高達50﹪，好發於30至50歲從事勞動工作者身上；而男性罹患機率約是女性的2至3倍。以此推估屏東縣80萬人口，約有8萬人可能患有尿路結石。患者會有腰部悶痛或腎部絞痛，噁心、嘔吐及血尿、排尿不暢的情形。
屏基泌尿科主治醫師李日馳指出，泌尿道包含腎臟、輸尿管、膀胱和尿道，腎臟輸尿管結石大多首選門診體外震波碎石來治療，適用於腎結石2.5公分以下，輸尿管1公分以下的結石病患，碎石成功率約7成。但是當結石位置不好或者體外震波碎石效果不佳，就必須考慮手術治療。相較於傳統經皮穿腎造廔手術，李日馳醫師表示，軟式輸尿管鏡碎石手術，運用軟式輸尿管腎臟鏡，轉彎角度可達270度，以雷射碎石，提高清除率，不但效果與傳統手術比較起來不相上下，且單一次使用降低感染風險，還減少腎臟損傷，沒有傷口，縮短住院天數。他提醒民眾及早處理結石，減少感染及癌化風險，若結石長期阻塞影響腎功能甚至最終導致洗腎。
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