摘要
目的探讨逼尿肌活力低下（DU）对良性前列腺梗阻（BPO）患者经尿道前列腺切除术（TURP）疗效的影响。方法回顾性分析2013年1月至2016年12月接受TURP治疗的157例BPO患者的临床资料。年龄48～86岁，平均70岁。所有患者均行尿动力学检查，膀胱收缩力指数（BCI）49．3～208．6，平均120．1。根据BCI值将患者分为两组：DU组（BCI〈100）47例，非DU组（BCI≥100）110例。／}15组和非DU组患者术前国际前列腺症状评分（Ipss）[（21．5±7．0）与（21．5±6．2）]、储尿期症状评分（IPSS—S）[（9．5±3．6）与（9．8±3．5）]、排尿期症状评分（IPSS-V）[（12．0±4．9）与（11。8±4．2）]、生活质量评分（QOL）[（5．1±0．8）与（5．3±0．7）]、最大自由尿流率（fQmax）[（6．5±3．5）ml／s与（7．6±5．0）m]／s]、残余尿量（PVR）[（137．4±146．2）ml与（105．2±135．9）m1]组间比较差异无统计学意义（P〉0．05）。术后3个月随访上述指标，将IPSS、IPSS—S、IPSS—V改善成功定义为术后／术前≤0．50，QOL改善成功定义为术前一术后≥3，fQmax改善成功定义为术后-术前≥5．0m]／s。比较两组患者上述指标改善程度及改善成功率。根据ROC曲线，将DU患者分为轻度DU组、重度DU组，比较两组相关指标改善成功率。结果DU组和非DU组术后IPSS[（8．6±7．3）与（4．4±4．5）]、IPSS—S[（5．0±3．5）与（3．6±2．8）]、IPSS—V[（3．6±5．1）与（0．9±2．3）]、QOL[（2．3±1．5）与（1．5±1．0）]、fQmax[（11．5±6．9）ml／s与（16．3±6．9）ml／s]、PVR[（48．4±65．6）ml与（23．6±25．6）m1]组间比较差异有统计学意义（P〈0．05），且两组分别与术前比较差异均有统计学意义（P〈0．05）相比差异均有统计学意义（P〈0．05），且组间比较差异有统计学意义（P〈0．05）；两组的IPSS、IPSS—S、IPSS—V、QOL、fQmax改善成功率分别为70．2％（33／47）、51．1％（24／47）、74．5％（35／47）、59．6％（28／47）、42．6％（20／47）和90．9％（100／110）、73．6％（81／110）、93．6％（103／110）、83．6％（92／110）、81．8％（90／1lO），差异有统计学意义（P〈0．05）。ROC曲线提示BCI=82时，约登指数最大，轻度DU（82≤BCI〈100）组与重度DU（BCI〈82）组的IPSS、IPSS—S、IPSS—V、fQmax改善成功率分别为82．8％（24／29）、58．6％（17／29）、86．2％（25／29）、48．3％（14／29）和50．0％（9／18）、38．9％（7／18）、55．6％（10／18）、33．3％（6／18），除IPSS—S、fQmax外，组间比较差异有统计学意义（P〈0．05）。结论合并DU的BPO患者TURP术后主客观指标均可获改善，但改善程度不如单纯BPO患者；合并重度DU的BPO患者术后排尿期症状改善较差，术前应充分沟通，告知合理预期。
Objective To analyze the impact of detrusor underactivity （DU） on the outcomes of transurethral resection of prostate （TURP） in patients with benign prostatic obstruction （BPO）. Methods A retrospective study was conducted in 157 BPO patients who underwent TURP from January 2013 to December 2016. Their ages ranged from 48 to 86 years with a mean age of 70 years. All patients underwent urodynamic study before surgery, bladder contraction index （BCI） ranged from 49.3 to 208.6, with a mean of 120. 1. The patients were divided into two groups according to BCI. DU group （BCI 〈 100 ） consisted of 47 patients, non-DU group （BCI i〉 100） 110patients. Before surgery, there were no significant differences in International Prostate Symptom Score （ IPSS ） , storage and voiding symptom scores of IPSS （IPSS-S, IPSS-V） , quality of life（QOL） , maximum free flow rate （fQmox） ,post-voided residual urine volume （PVR） between the two groups[（21.5±7.0）vs. （21.5±6.2）,（9.5±3.6）vs. （9.8±3.5）,（12.0± 4.9）vs.（11.8±4.2）,（5.1±0.8）vs. （5.3-0.7）,（6.5±3.5）ml/s vs. （7.6±5.0）ml/s,（137.4± 146. 2） ml vs. （ 105.2 ± 135.9） ml ] （ P 〉 O. 05 for each）. The outcomes of TURP were assessed by the above mentioned parameters at 3 months postoperatively;IPSS,IPSS-S,IPSS-V were regarded as successful if they improved more than 50% , QOL was successful if it was improved more than 3, fQ successful if it was improved 5ml/s. The change and successful improvement rates of the above mentioned parameters were compared between DU and non-DU group. Through receiver operating characteristic curve（ROC） analysis , patients were categorized into mild DU and severe DU group and compared the successful improvement rates between the two groups. Results Both DU group and non-DU group improved significantly in IPSS,IPSS-S, IPSS-V, QOL, fQmax, PVR at 3 months postoperatively （P 〈 0. 05 ）and the two groups differed significantly in those parameters [（8.6-7.3）vs. （4.4±4.5）,（5.0±3.5）vs. （3.6±2.8）,（3.6±5.1）vs. （0.9± 2.3）,（2.3±1.5）vs. （1.5 ±1.0）,（11.5 ±.9）ml/s vs. （16.3 ±.9）ml/s,（48.4±65.6）ml vs. （23.6 ± 25.6） ml ] （ P 〈 0. 05 for each）. In regard to the successful improvement rates of IPSS, IPSS-S, IPSS-V, QOL, fQ DU group was less successful than non-DU group [ 70. 2% （33/47）vs. 90. 9% （100/110）,51.1% （24/47）vs. 73.6% （81/110）,74.5% （35/47）vs. 93.6% （103/110）,59.6% （28/47）vs. 83.6% （92/110） ,42. 6% （20/47）vs. 81.8% （90/110） ,P 〈0. 05 for each]. Youden index was maximum when BCI equaled to 82. There were significant differences in the successful improvement rates of IPSS and IPSS-V between mild DU （82 ~〈 BCI 〈 100） and severe DU （BCI 〈 82） group[ 82. 8% （24/29） vs. 50.0% （9/18）, 86.2% （25/29） vs. 55.6% （ 10/18 ）, P 〈 0. 05 for each ）, no significant differences in IPSS-S and fQmax [ 58.6% （17/29） vs. 38.9% （7/18） ,48.3% （ 14/29 ） vs. 33.3% （6/18）, P 〉 0. 05 for each ]. Conclusions Benign prostatic obstruction patients with DU can achieve improvement in both subjective and objective parameters after TURP, but patients without DU can get more improvement. BPO patients with severe DU patients show a worse improvement of the voiding symptom. Surgeons should have adequate communication with the patients and inform them of appropriate expectations.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第11期815-819,共5页
Chinese Journal of Urology
