経尿道的前立腺電気蒸散切除術(Transurethral electrovaporization of the prostate;TVP)の組織学的検討

Abstract

1)Standard loop, Roller loop, new electrode device of thick loop(Band & Wedge Loop)の切除切片の組織診断可能な面積比を求めた. 2)組織診断可能部分の面積比は, 通常のTUR用ループの組織では92.0±3.3%, Roller Loopでは2.4±0.9%, 通常型蒸散ループではBand Loopで42.7±27.1%, Wedge Loopで39.7±24.4%であった. 3)切除速度に関しては通常のTURループ使用時よりも1/2程度の方がより実際的で, 蒸散効果も得られると思われた

Transurethral electrovaporization of the prostate (TVP) has been devised to eliminate prostatic tissue by electric vaporization and to create a dry coagulation layer beneath to minimize bleeding from the site of TVP. However, vaporization induces degeneration due to thermal coagulation deep in the tissue beneath the vaporized layer, and local tissue damage is thus greater than that caused by the standard transurethral resection of prostate (TURP) loop. Since this results in difficulty with histopathological examination, the percentages of tissue-diagnosable area were determined in sections resected using various vaporization electrodes (Roller Loop, Band & Wedge Loop). The percentage of tissue-diagnosable area was 92.0 +/- 3.3% with the standard TUR loop, 2.4 +/- 0.9% with the Roller Loop, 42.7 +/- 21.1% with the Band Loop, and 39.7 +/- 24.4% with the Wedge Loop. Concerning speed of resection, the best vaporization effect was obtained when the speed of operation was 1/2 or 1/3 that with the standard TUR loop. Since the region in which tissue diagnosis was smaller with the vaporization electrode than with standard TURP, more careful examination was required for diagnosis of incidental cancers. Therefore, postoperative observation by PSA measurement appeared to be important.