超选择前列腺动脉栓塞联合经尿道前列腺切除术治疗体积＞80 mL良性前列腺增生的临床疗效

doi:10.3969/j.issn.1003-9198.2021.01.016

摘要/Abstract

摘要： 目的比较超选择前列腺动脉栓塞(PAE)+经尿道前列腺切除术(TURP)与单纯TURP方案治疗前列腺体积＞80 mL良性前列腺增生的疗效及安全性。方法回顾性分析我院2016年1月至2019年1月收治的84例体积＞80 mL良性前列腺增生病人的临床资料,其中行单纯TURP治疗者44例为对照组,行超选择PAE+TURP治疗者40例为观察组。比较2组手术时间、切除病变组织重量和速率、膀胱持续冲洗时间、尿管留置时间、手术前后国际前列腺症状评分(IPSS)、生活质量(QOL)评分、最大尿流率(Qmax)、残余尿量(PVR)及术后并发症发生率。结果观察组手术时间、膀胱持续冲洗时间及尿管留置时间均显著少于对照组(P<0.05),切除病变组织重量和速率均显著高于对照组(P<0.05)。2组术后IPSS评分、QOL评分、Qmax及PVR水平差异均无统计学意义(P>0.05);观察组术后并发症发生率显著低于对照组(P<0.05)。结论对于体积＞80 mL良性前列腺增生病人,超选择PAE+TURP方案较单纯TURP方案能够有效缩短手术时间,提高组织切除效率,加快术后康复进程,缓解临床症状,改善膀胱功能和生活质量,并有助于降低术后并发症发生风险。

关键词: 前列腺动脉栓塞, 经尿道前列腺切除术, 良性前列腺增生, 老年人

Abstract: Objective To investigate the clinical effects and safety of super-selective prostatic artery embolization (PAE) combined with transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia with volume>80 mL in the elderly patients. Methods The clinical data of 84 elderly patients with benign prostatic hyperplasia with volume>80 mL treated in our hospital from January 2016 to January 2019 were retrospectively analyzed. The patients were divided into control group (44 patients, undergoing TURP) and observation group (40 patients, undergoing super-selective PAE and TURP). The operation time, weight and speed of excised lesion, continuous bladder flushing time, catheter retention time, International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum urinary flow rate (Qmax) and residual urine volume (PVR), and postoperative complications were compared between the two groups. Results Compared with the control group, the operation time, continuous bladder flushing time, catheter retention time in the observation group were significantly less (P<0. 05), and the weight and speed of excised lesion were significantly more (P<0. 05). After operation, there were no significant differences in IPSS score, QOL score, Qmax and PVR between the two groups (P>0. 05), but the incidence rate of postoperative complication in observation group was significantly lower than that in control group (P<0. 05). Conclusions Compared with TURP alone, super-selective PAE + TURP in the treatment of benign prostatic hyperplasia patients with volume > 80 mL can efficiently shorten the operation time, increase the efficiency of tissue resection, speed up the rehabilitation process, relieve the clinical symptoms, improve the bladder function and quality of life, and reduce the postoperative complications risk.

Key words: prostatic artery embolization, transurethral prostatectomy, benign prostatic hyperplasia, aged

中图分类号:

R 697.32

朱琳杰, 王伟, 王海东, 赵新建. 超选择前列腺动脉栓塞联合经尿道前列腺切除术治疗体积＞80 mL良性前列腺增生的临床疗效[J]. 实用老年医学, 2021, 35(1): 61-64.

ZHU Lin-jie, WANG Wei, WANG Hai-dong, ZHAO Xin-jian. Curative effect of super-selective prostatic artery embolization combined with transurethral prostatic resection for benign prostatic hyperplasia with volume>80 mL[J]. Practical Geriatrics, 2021, 35(1): 61-64.

参考文献

[1] 郝一昌, 肖春雷, 卢剑, 等. “点线面体”四维法钬激光前列腺剜除术治疗良性前列腺增生的临床研究[J]. 中华外科杂志, 2019, 57(3):194-199.
[2] CHAABANE W. Bipolar anatomical enucleation of prostate for benign prostatic hyperplasia: First Tunisian Experience[J]. Eur Urol Suppl, 2018, 17(4):e2100.
[3] RAY A F, POWELL J, SPEAKMAN M J, et al. Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study)[J]. BJU Int, 2018, 122(2):270-282.
[4] THULASIDASAN N, KOK H K, EKHAGE O, et al. Prostate artery embolisation: an all-comers, single-operator experience in 159 patients with lower urinary tract symptoms, urinary retention, or haematuria with medium-term follow-up [J]. Clin Radiol, 2019, 74(7):569.e1-569.e8.
[5] 米军, 汪林军. 大体积良性前列腺增生:选择何种术式?[J]. 中华男科学杂志, 2019, 25(5):387-391.
[6] 马丁, 尚吉文, 王靖宇, 等. 良性前列腺增生临床进展危险因素与分子标志物的相关性研究[J]. 中华泌尿外科杂志, 2018, 39(3):226-227.
[7] 谷猛, 刘冲, 陈彦博, 等. 解剖标志导航钬激光剜除术治疗大体积前列腺增生的疗效分析[J]. 中华泌尿外科杂志, 2019, 40(3):206-209.
[8] JIANG Y, BAI X, ZHANG X, et al. Comparative study of the effectiveness and safety of transurethral bipolar plasmakinetic enucleation of the prostate and transurethral bipolar plasmakinetic resection of the prostate for massive benign prostate hyperplasia (>80 ml) [J]. Med Sci Monit, 2020, 26(4):e921272.
[9] MALLIKARJUNA C, NAYAK P, GHOUSE S M, et al. Transurethral enucleation with bipolar energy for surgical management of benign prostatic hyperplasia: our initial experience[J]. IJU, 2018, 34(3):219-222.
[10] RIO TINTO H, MARTINS PISCO J, BILHIM T, et al. Prostatic artery embolization in the treatment of benign prostatic hyperplasia: short and medium follow-up[J]. Tech Vasc Interv Radiol, 2012, 15(4):290-293.
[11] AYYAGARI R, POWELL T, STAIB L, et al. Prostatic artery embolization using 100-300-μm trisacryl gelatin microspheres to treat lower urinary tract symptoms attributable to benign prostatic hyperplasia: A Single-Center Outcomes Analysis with Medium-Term Follow-up [J]. J Vasc Interv Radiol, 2019, 23(11):30692-30700.
[12] CARNEVALE F C, SOARES G R, DE ASSIS A M, et al. Anatomical variants in prostate artery embolization: A Pictorial Essay [J]. Cardiovasc Intervent Radiol, 2017, 40(9):1321-1337.
[13] PETRILLO M, PESAPANE F, FUMAROLA E M, et al, State of the art of prostatic arterial embolization for benign prostatic hyperplasia[J]. Gland Surg, 2018, 7(2):188-199.
[14] QIU Z, ZHANG C, WANG X, et al. Clinical evaluation of embolization of the superior vesical prostatic artery for treatment of benign prostatic hyperplasia: a single-center retrospective study[J]. Wideochir Inne Tech Maloinwazyjne, 2017, 12(4):409-416.

[1]	丛晓飞, 李铭麟, 石春来. 老年口腔衰弱与多重用药的关系及干预策略[J]. 实用老年医学, 2024, 38(9): 872-875.
[2]	李毛毛, 张飞, 沈鑫, 李洁华. 老年人口腔衰弱与跌倒关系的研究进展[J]. 实用老年医学, 2024, 38(9): 876-879.
[3]	张飞, 李毛毛, 李铭麟, 王佳贺. 老年人口腔衰弱与抑郁症的相关性研究进展[J]. 实用老年医学, 2024, 38(9): 884-888.
[4]	李江, 邱雁, 王婷, 王丹, 虞一帆, 濮玲丽, 卜玲. 老年肺腺癌病人术前全身免疫炎症指数/血清白蛋白与临床病理特征的相关性研究[J]. 实用老年医学, 2024, 38(9): 893-896.
[5]	戴静, 崔焱. 糖化血红蛋白变异性与老年2型糖尿病病人认知功能障碍的相关性分析[J]. 实用老年医学, 2024, 38(9): 931-935.
[6]	张星星, 张海洋, 何小菁, 鲁翔. 不同肥胖指标与老年人糖尿病患病风险的调查研究[J]. 实用老年医学, 2024, 38(9): 940-943.
[7]	倪红艳, 陈云, 张其兵, 马一鸣, 解成兰. 电针对老年病人下肢骨科手术围术期认知功能及炎症因子的影响[J]. 实用老年医学, 2024, 38(9): 944-947.
[8]	李晓敏, 李晓林, 栗杰, 吴蕾, 郝冉冉. 老年病人经肛双气囊小肠镜进镜效率及其影响因素研究[J]. 实用老年医学, 2024, 38(9): 958-961.
[9]	蔡荟萃, 陈燕, 王燕, 叶劲军, 朱钰颖. 多形式健康教育模式联合简易呼吸功能锻炼对老年肺癌放疗病人癌因性疲乏及遵医行为的影响[J]. 实用老年医学, 2024, 38(9): 968-972.
[10]	李湘, 栗萱, 田应选. 肺衰老与慢性呼吸系统疾病研究现状及进展[J]. 实用老年医学, 2024, 38(8): 761-765.
[11]	王小娇, 王宁, 崔宏, 叶童, 王晓明. 运动康复对老年轻中度慢性心力衰竭病人的疗效评价[J]. 实用老年医学, 2024, 38(8): 775-778.
[12]	郝世杰, 邹建鹏, 卫晨, 刘清江. 综合呼吸训练对老年帕金森病病人运动减少型构音障碍的影响[J]. 实用老年医学, 2024, 38(8): 783-787.
[13]	向超, 罗彩东. 心电图avL导联T波变化对老年冠心病病人冠脉狭窄程度的诊断价值[J]. 实用老年医学, 2024, 38(8): 788-791.
[14]	李慧颖, 蔡力力, 朱启伟. 血浆N末端脑钠肽前体对高龄左室肥厚病人预后的预测价值[J]. 实用老年医学, 2024, 38(8): 797-801.
[15]	王新平, 谢柏梅, 卫国, 叶晓莉, 赵亚芸, 谭小田. 老年特发性间质性肺炎病人血清S100A9及sCD163表达水平及临床意义[J]. 实用老年医学, 2024, 38(8): 802-807.