摘要
目的探讨超选择性前列腺动脉栓塞(PAE)联合经尿道前列腺切除术(TURP)治疗重度前列腺增生(前列腺体积〉80ml)的安全性及疗效。方法回顾性分析2015年3月至2017年6月收治的40例重度前列腺增生且药物治疗无效患者的临床资料。其中联合组(PAE+TURP)18例,年龄60-88岁,平均(75.0±8.7)岁;前列腺体积83-145ml,平均(111.0±23.3)ml;术前国际前列腺症状评分(IPSS)(25.2±3.6)分,生活质量评分(QOL)(5.1±1.0)分,最大尿流率(Qmax)(6.4±2.3)ml/s,残余尿量(PVR)(107.7±32.6)ml。TURP组22例,年龄62-85岁,平均(76.0±6.9)岁;前列腺体积80-150ml,平均(107.5±27.4)ml;IPSS(24.3±4.2)分,QoL(4.9±0.9)分,Qmax(6.7±2.2)ml/s,PVR(106.6±32.2)ml。比较两组的手术时间、术中出血量、切除腺体组织重量及切除效率、术后持续膀胱冲洗时间及留置尿管时间、IPSS、QoL、Q。。和PVR等指标,以及术后并发症发生情况。结果联合组和TURP组在手术时间[(75.8±25.1)rain与(103.2±27.7)min]、术中出血量[(122.8±33.9)ml与(447.6±36.0)m1]、前列腺组织切除重量[(99.9±24.2)g与(82.9±15.5)g]及效率[(76.9±20.7)g/h与(41.7±14.2)g/h]、术后持续膀胱冲洗时间[(1.4±0.5)d与(2.4±0.8)d]及留置尿管时间[(2.2±0.4)d与(3.4±0.6)d]等方面比较差异均有统计学意义(P〈0.05)。联合组术后无再次出血和二次电切病例,发生暂时性尿失禁2例,泌尿系感染1例。TURP组术后发生再次出血3例,二次电切3例,暂时陛尿失禁4例,泌尿系感染2例。术后随访1年,联合组和TURP组的IPSS评分分别为(6.7±1.5)分和(6.9±1.5)分,QOL评分分别为(2.3±0.5)分和(2.3±0.6)分,Qmax分别为(15.6±2.3)ml/s和(15.0±2.1)ml/s,PVR分别为(32.8±6.5)ml和(32.3±8.4)ml,两组与术前比较差异均有统计学意义(P〈0.05),两组间比较差异均无统计学意义(P〉0.05)。结论对于前列腺体积〉80ml的重度BPH患者,PAE联合TURP具有术中出血少、电切效率高、并发症少等优点,是一种安全、有效的治疗方法。
Objective To explore the safety and efficacy of super-selective prostate artery embolization (PAE) combined with TURP ( transurethral resection of prostate) as an alternative method for patients with severe large BPH ( 〉 80 ml). Methods From March 2015 to June 2017,a total of 40 patients with large benign prostatic hyperplasia who failed in medical treatment were selected for PAE combined with TURP ( 18 cases) and TURP (22 cases). In the PAE combined with TURP group, the mean age was (75.0±8.7) years ( ranging 60 - 88 years) and the mean prostatic volume was ( 111.0 ± 23.3 ) ml, ranged from 83 to 145 ml ). The international prostate symptom score ( IPSS), quality of life ( QOL), maximal urine flow rate ( Qmax ) and postvoid residual urine (PVR) were ( 25.2 ± 3.6), ( 5.1 ± 1.0), ( 6.4 ± 2.3 ) ml/s and ( 107.7± 32.6) ml, respectively. In the TURP group, the mean age was ( 76.0 ± 6.9 ) years ( ranging 62 -85 years) and the mean prostatic volume was (107.5 ± 27.4) ml, ranged from 80 to 150 nd). The IPSS, QOL, Q and PVR were(24.3 ± 4.2 ), (4.9 ± 0.9 ), ( 6.7 ± 2.2 ) ml/s and ( 106.6 ± 32.2 ) ml, respectively. Clinical data of all of patients were analyzed retrospectively, including operative time, estimate blood loss,weight and efficacy of resected tissue, time of continuous bladder iwigation and catheterization, IPSS, QOL, PVR, Q and postoperative complications. Results There were significant differences in the operative time [ (75.8 ± 25.1 ) rain vs. ( 103.2 ± 27.7) min ~, estimate blood loss [ ( 122.8±33.9) ml vs. (447.6 ± 36.0) ml ], weight of resected tissue [ (99.9 ± 24.2 ) g vs. ( 82.9 ±15.5 ) g ], efficacy of resected tissue [ (76.9 ±20.7 ) g/h vs. (41.7± 14.2) g/h I, continuous bladder irrigation time [ ( 1.4± 0.5 ) d vs. (2.4 ± 0.8 ) d ] and catheterization time [ (2.2 ± 0.4) d vs. (3.4 ±0.6) d ] between PAE combined TURP group and TURP group ( P 〈 0.05 ). The postoperative complications of PAE combined TURP group and TURP group were included secondary hemorrhage (0 case vs. 3 cases ) , secondary TURP (0 case vs. 3 cases ), temporary urinary incontinence ( 2 case vs. 4 case), urinary tract infection ( 1 case vs. 2 case). After 1 -year follow up, the IPSS, QOL, Qmax and PVR of PAE combined TURP group and TURP group were (6.7±1.5)and(6.9±1.5),(2.3 ±0.5)and(2.3±0.6),(15.6±2.3)ml/s and(15.0±2.1) ml/s, (32.8 ± 6.5) ml and(32.3 ± 8.4)ml, respectively. Both groups were found to have significantly improved in IPSS, QOL, Q and PVR, as compared with preoperative indexes, respectively ( P 〈 0.05 ). However, there was no significant difference in those indexes between two groups ( P 〉0.05 ). Conclusions PAE combined TURP could be used a safe and effective volume ( 〉 80 ml) BPH. It has been a priority in postoperative complications. therapy for treating patients with LUTS due to large less blood, more efficient of resected tissue and less postoperative complications.
作者
吕磊
黄韬
高晓玲
章传华
黄遂斌
Lyu Lei;Huang Tao;Gao Xiaoling;Zhang Chuanhua;Huang Suibin(Department of Urology,Wuhan NO.1 Hospital,Hubei Wuhan 430030,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第9期675-678,共4页
Chinese Journal of Urology
基金
国家自然科学基金(81502204)
湖北省自然科学基金(2014CFB399)
关键词
良性前列腺增生
前列腺动脉栓塞
下尿路症状
Benign prostatic hyperplasia
Prostatic artery embolization
Low urinary tract symptoms