老年前列腺增生患者经尿道绿激光气化切除术后储尿期症状改善的多因素分析  

Multivariate analysis of long-term outcomes of storage symptom improvement in elderly patients with benign prostatic hyperplasia after GreenLight laser vaporization

作　　者：王建龙[1] 陈毅来 王蕾蕾[3] 刘明[1] 吴鹏杰[1] 张耀光[1] 万奔[1] 王建业[1] 邓小虎 Wang Jianlong;Chen Yilai;Wang Leilei;Liu Ming;Wu Pengjie;Zhang Yaoguang;Wan Ben;Wang Jianye;Deng Xiaohu(Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China;Department of Urology, Karamay Municipal People's Hospital, Karamay 834000, China;Department of Special Health Care, Beijing Hospital, National Center of Gerontology, Beijing 100730, China)

机构地区：[1]北京医院泌尿外科国家老年医学中心,100730 [2]新疆克拉玛依市人民医院泌尿外科,834000 [3]北京医院特需医疗部国家老年医学中心,100730

出　　处：《中华老年医学杂志》2019年第2期196-200,共5页Chinese Journal of Geriatrics

摘　　要：目的分析术前尿动力学参数与经尿道绿激光手术治疗后下尿路症状(储尿期症状)改善状况之间的关系,探索确定储尿期症状改善的预后因子。方法回顾性分析2015年7月至2017年3月于北京医院泌尿外科就诊并接受经尿道绿激光手术的老年前列腺增生患者100例,所有患者均在术前完成尿动力学检查评估并接受经尿道绿激光气化切除术治疗。收集患者临床资料,如年龄、前列腺特异抗原、前列腺体积、国际前列腺症状评分(IPSS)、膀胱过度活动症评分(OABSS)、生活质量评分(QOL)及完整的尿动力学参数等,采用二分类Logistic回归分析患者经尿道绿激光气化切除术后储尿期症状改善的相关因素。结果100例患者全部顺利实施手术并完成12个月的随访,患者各项评分比较显示激光气化切除术后3个月及12个月时,患者无论储尿期症状还是排尿期症状均取得明显改善(P<0.05)。患者激光气化切除术后3个月及12个月时,IPSS、下尿路储尿期症状评分(IPSS-S)、下尿路排尿期症状评分(IPSS-V)、OABSS、QOL各项评分较手术前减少,夜尿次数较手术前减少,患者储尿期症状、排尿期症状均取得明显改善(均P<0.05);储尿期症状改善成功率在术后3、12个月分别为IPSS-S62.0%(62/100)、68.0%(68/100),OABSS68.0%(68/100)、75.0%(75/100)。多因素Logistic回归分析结果显示,年龄、逼尿肌收缩力、残余尿量、夜尿次数是术后影响预后的独立影响因素(OR=35.714、0.352、0.110、0.040,P=0.000、0.027、0.018、0.002)。结论经尿道绿激光手术是治疗前列腺增生合并膀胱过度活动症的有效手段,年龄是患者术后储尿期症状改善不佳的独立影响因素;残余尿量、夜尿次数、逼尿肌收缩力是术后影响储尿期症状改善的独立影响因素,术前应给予相关指标充分的重视。Objective To investigate the relationship between preoperative urodynamic parameters and the improvement of overactive bladder(OAB)symptoms after GreenLight laser vaporization, and to explore prognostic factors for improvement of OAB symptoms in the elderly. Methods A retrospective study was conducted in 100 benign prostatic hyperplasia(BPH)patients undergoing GreenLight laser vaporization at the Department of Urology of Beijing Hospital from July 2015 to March 2017.All patients completed a preoperative urodynamic examination and received GreenLight laser vaporization.Clinical data including age, prostate-specific antigen(PSA), prostate volume, international prognostic scoring system(IPSS), overactive bladder symptom score(OABSS), quality of life(QOL)and urodynamic parameters were collected.The related factors for improvement of OAB symptoms after GreenLight laser vaporization were analyzed by a binary Logistic regression analysis. Results All patients underwent surgery successfully and completed a 12-month follow-up.Both urinary storage and voiding symptoms improved at 3 and 12 months after GreenLight laser vaporization(P<0.05). The scores of IPSS, IPSS storage(IPSS-S), IPSS voiding(IPSS-V), OABSS and QOL and nighttime voiding frequency decreased and urinary storage and voiding symptoms improved at 3 and 12 months after GreenLight laser vaporization, compared with pre-surgery data(P<0.05). The success rates of storage symptom improvement at 3 and 12 months after GreenLight laser vaporization were 62.0%(62/100)and 68.0%(68/100)evaluated by IPSS-S and 68.0%(68/100)and 75.0%(75/100)by OABSS, respectively.Multiple Logistic regression analysis showed that age, detrusor contractility, residual urine volume and nighttime voiding frequency were independent influencing factors for prognosis(OR=35.714, 0.352, 0.110 and 0.040, P=0.000, 0.027, 0.018 and 0.002). Conclusions GreenLight laser vaporization is an effective method in treating BPH with OAB.Age is an independent unfavorable factor and the residual urine volume, nig

关 键 词：前列腺增生 膀胱 过度活动性 

分 类 号：R699.8[医药卫生—泌尿科学]