摘要
目的探讨经尿道柱状水囊扩开术治疗良性前列腺增生(BPH)的疗效。方法回顾性分析2016年6月至2018年7月安徽医科大学第一附属医院采用经尿道柱状水囊扩开术治疗的25例BPH患者的临床资料。年龄中位值80岁(57~94岁),前列腺体积中位值75 ml(30~176 ml),术前最大尿流率(Qmax)中位值6 ml/s(2~9 ml/s),国际前列腺症状评分(IPSS)中位值25分(18~34分),术前生活质量评分(QOL)中位值4分(3~5分),术前残余尿量中位值85 ml(30~510 ml)。术前国际勃起功能评分量表(IIEF-5)评分中位值11分(5~21分)和射精功能量表(PEDT)评分中位值10分(6~17分)。手术方法:精确定位后先向内囊注入5 ml生理盐水,在前列腺尖部触到内囊,固定导管,再向外囊注水使压力达2.5 kPa,放缓注水速度,当外囊压力稳定在3.0 kPa后,停止注水,注意观察压力表,当前列腺腺体裂开时,需继续补水维持压力在3.0 kPa,持续5 min。比较手术前后IPSS、QOL、Qmax和残余尿量等指标;对有正常性生活者评估有无逆向射精和精液量减少,比较手术前后IIEF-5评分和PEDT评分变化。结果1例前列腺连续两次扩裂未能裂开,2例前列腺为6点方向裂开,此3例改行前列腺等离子电切术;其余22例手术均顺利完成。22例手术时间中位值17 min(11~23 min),血红蛋白丢失量中位值19 g/L(15~22 g/L),膀胱持续冲洗时间中位值1 d(1~2 d),术后留置导尿管时间中位值10 d(7~11 d),术后住院时间中位值11 d(7~12 d)。20例随访12个月,术后IPSS中位值8分(4~14分),较术前降低(P<0.001);术后Qmax中位值17 ml/s(9~25 ml/s),较术前升高(P<0.001);术后残余尿量中位值10 ml(0~150 ml),较术前降低(P<0.001)。术后QOL中位值1分(1~2分),较术前明显降低(P<0.05)。16例有正常性生活者术后未发现逆向射精和精液量减少,术后IIEF-5评分16分(7~24分),PEDT评分8分(6~14分),与术前比较差异均无统计学意义(P>0.05)。结论经尿道柱状水囊扩开术治疗BPH具有手术时间短,出血量少,有效改善残余尿和排尿困难症状,临床效果确切,且对性功能影响较小,适用于有保留性功能需求的高危BPH患者。
Objective To evaluate the clinical efficacy and safety of transurethral columnar balloon dilation of prostate(TUCBDP)in treatment of patients with benign prostatic hyperplasia(BPH).Methods A retrospective analysis was performed on 25 cases of BPH treated by TUCBDP in the First Affiliated Hospital of Anhui Medical University from June 2016 to July 2018.The median age was 80(57-94)years,and the median volume of prostate was 75(30-176)ml.The median preoperative maximum urine flow rate(Qmax)was 6(2-9)ml/s,the median quality of life score(QOL)was 4(3-5)points.The median preoperative international prostate symptom score(IPSS)and residual urine volume(RUV)was 25(18-34)and 85(30-510)ml respectively.The median preoperative international index of erectile function questionnaire-5(IIEF-5)score was 11(5-21)points and the median preoperative premature ejaculation diagnostic tool(PEDT)score was 10(6-17)points.The standard procedure of TUCBDP includes injecting 5ml of normal saline into the inner capsule,touching the inner capsule at the apex of prostate,fixing the catheter and then injecting water into the outer capsule to make the pressure reach 2.5 kPa.When the pressure of the outer capsule was maintained at 3 kPa for 5 minutes,the prostate was split.The peroperative IPSS,QOL,Qmax and RUV was compared.The IIEF-5 and PEDT score before and after surgery were compared in patients with normal sexual activity to evaluate whether there were reverse ejaculation and semen reduction.Results One case of BPH failed to rupture and the other two cases was split at 6 o’clock.The three cases were converted to plasma resection.The rest 22 cases were operated successfully with the median operation time of 17(11-23)min,the hemoglobin loss of 19(15-22)g/L.The continuous bladder flushing time was 1(1-2)d,the indwelling catheter time was 10(7-11)d and the hospital stay time was 11(7-12)d.Twenty of 25 cases were followed-up for 12 months.IPSS was 8(4-14)points,Qmax was 17(9-25)ml/s,and RUV was 10(0-150)ml;there were significant differences between the peroperative and postoperative(all P<0.001).The median QOL was 1(1-2)point,decreased than peroperative(P<0.05).No adverse ejaculation and semen reduction were found in the post-operative patients with normal sexual life.The post-operative IIEF-5 and PEDT score was 16(7-24)points and 8(6-14)points respectively,which was not significantly different while compared with pre-operative IIEF-5 and PEDT score.Conclusions TUCBDP was proved to be effective and safe for treating high-risk BPH patients with the advantages of short operation time,less bleeding,significant improvement of residual urine and dysuria.
作者
张翼飞
尹水平
王子成
张贤生
梁朝朝
Zhang Yifei;Yin Shuiping;Wang Zicheng;Zhang Xiansheng;Liang Chaozhao
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2020年第7期527-530,共4页
Chinese Journal of Urology
关键词
前列腺增生
前列腺扩裂术
柱状水囊
疗效
Prostatic hyperplasia
Dilation of prostate
Cylindrical water sac
Effect
