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目的探讨影响激光作用于前列腺组织生物学效应的因素，指导改进激光手术操作。方法对４例拟行前列腺切除术的前列腺增生症患者，在开放手术前先以不同功率（３０、４５、６０、７０Ｗ）的Ｎｄ∶ＹＡＧ激光经尿道非接触式照射前列腺组织６０ｓ或９０ｓ，术后取切除的前列腺组织行光镜、电镜及免疫组化系列观察。结果受照射组织坏死区直径为８～１６ｍｍ。随激光功率增加，组织受损范围相应增加，但作用时间均为６０ｓ时，６０Ｗ和７０Ｗ两种功率造成的组织损伤范围大致相同；激光功率均为６０Ｗ时，照射时间由６０ｓ延长至９０ｓ，组织损伤范围也大致相同。当激光功率和作用时间恒定时，术中膀胱冲洗液流速慢者组织损伤范围大于流速快者。结论激光功率、照射时间及冲洗液流速是影响激光对前列腺组织生物学效应的重要因素，采用功率６０Ｗ、每点照射６０ｓ能产生较好的激光生物学效应；对不同治疗部位应采用不同功率和作用时间；常规四点照射不能保证激光对组织的作用深度和范围，应改为六点照射。
Objective To explore the factors affecting the biological effect of laser on prostate tissue and to guide the improvement of laser surgery. Methods Four patients undergoing prostatectomy for benign prostatic hyperplasia (BPH) were treated with non-contact urethral irradiation of Nd:YAG laser for 60s or 90s with open-circuit surgery (30,45,60,70W) After removal of the prostate tissue line light microscope, electron microscopy and immunohistochemistry series observation. Results The diameter of irradiated tissue necrosis area was 8 ~ 16mm. With the increase of laser power, the damaged area of the tissue increased correspondingly. However, when the time was 60s, the range of tissue damage caused by the two powers of 60W and 70W were the same. When the laser power was 60W, the irradiation time was prolonged from 60s to 90s, Damage range is also roughly the same. When the laser power and duration of action is constant, the rate of intraoperative bladder irrigation fluid flow rate of tissue damage greater than the faster flow rate. Conclusions Laser power, irradiation time and flow rate of rinsing fluid are important factors affecting the biological effects of laser on prostate tissue. The best laser bioeffect can be obtained at 60 W for 60 s. The different treatment sites should use different power and Role of time; conventional four-point irradiation can not guarantee the depth and scope of the role of laser on the organization should be changed to six-point irradiation.