良性前列腺增生致膀胱出口梗阻合并逼尿肌功能减弱患者行经尿道前列腺电切术疗效的影响因素分析  

Analysis of TURP efficacy in BOO/BPH with detrusor underactivity

作　　者：邱智[1] 吴栗洋 周晓光[1] 武治津[1] 范立新[1] 耿一博[1] 肖嘉昱 张小东[1] 

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,北京100026

出　　处：《中华泌尿外科杂志》2016年第7期511-514,共4页Chinese Journal of Urology

摘　　要：目的探讨良性前列腺增生（BPH）导致膀胱出口梗阻（BOO）合并逼尿肌功能减弱（detrusor underactivity，DU）患者经尿道前列腺电切（TURP）术后疗效的影响因素。 方法回顾性分析2012年1月至2014年12月收治的44例BPH导致BOO合并DU患者的临床资料，根据TURP术后排尿情况分为2组：A组（无效组）9例（20.5%），其中5例保留导尿，3例行膀胱造瘘术，1例行自家导尿。B组（有效组）35例（79.5%）。A组和B组的术后最大尿流率分别为（3.1±1.0）ml/s和（14.5±8.2）ml/s，残余尿量分别为（183.8±110.3）ml和（17.4±38.2）ml，IPSS分别为（23.3±6.3）分和（8.3±5.2）分，QOL评分分别为（5.4±1.2）分和（1.4±1.0）分，差异均有统计学意义（P〈0.01）。比较A组和B组术前临床资料；选取BPH导致BOO未合并DU患者46例作为C组（对照组），比较B组和C组手术前后的尿动力学数据，分析影响TURP疗效的因素。 结果A组与B组的术前因素中，糖尿病史（3例vs.4例）、逼尿肌顺应性[（28.8±11.3）ml/cmH20 vs.（36.0±27.9）ml/cmH20]（1cm H2O＝0.098kPa）、残余尿量[（293.8±120.7）ml vs.（181.0±139.7）ml]、前列腺总体积[（42.0±23.7）cm3 vs.（60.6±20.1）cm3]等差异有统计学意义（P〈0.05）。多因素回归分析显示前列腺总体积（OR＝0.919，P＝0.025）和术前残余尿量（OR＝1.012，P＝0.033）是影响BOO合并DU患者术后排尿功能的危险因素。B组与C组术前因素比较，年龄[（74.9±7.1）岁vs.（70.9±7.7）岁]、最大尿流率[（3.5±2.5）ml/s vs.（5.2±2.9）ml/s]、最大尿流率时逼尿肌压[ （ 34.8±20.8）cm H2O vs.（76.8±18.3） cm H2O ]、残余尿量[（181.0±139.7）ml vs.（93.7±92.7）ml]、梗阻级别[（1.8±1.4）vs.（3.8±1.1）]、前列腺内腺体积[（32.4±24.0）cm3 vs.（47.8±23.1）cm3]等差异有统计学意义（P〈0.05）。B组与C组术后因素比较，留置尿管时间[（11.8±6.3）d vs.（4.7±2Objective To investigate the factors influencing the TURP＇s therapeutic effeciency on the benign prostatic hyperplasia （BPH） patients with bladder outlet obstruction （BOO） and detrusor underacfivity （DU）. Methods 90 BPH patients with BOO treated by TURP in our hospital （2012. 1- 2014. 12） were included in this study. All the patients were divided into three groups according to their outcome ： Group A, the patients with BPH, BOO, DU and inability to urinate after surgical operation. Group B, those with BPH, BOO, DU and self-urination after TURP. Group C, those who only presented BPH with BOO and self-urination after TURP. The pre- and postoperative data of three groups were statistically analyzed. Results In group A and group B, 9 cases （Group A） presented inability to urinate after TURP（20. 5%, 9/44）. Among them, detrusor compliance and preoperative prostate volume in group A were significantly lower than in group B, and the residual urine volume was significantly higher than that in group B （ all P 〈 0. 05 ）. With multivariate logistic regression analysis, we found that preoperative prostate volume （0R=0.919, P =0.025） and preoperative residual urine volume （OR = 1.012, P =0.033） were significant predictors of TURP＇s efficiency in treating BOO/DU patients. There was no statistical difference in Q PVR, IPSS score and QOL score between the group B and group C. Conclusion The results of our study confirmed that TURP is an effective treatment for BPH patients associated with BOO and DU. Preoperative prostate volume and preoperative residual urine volume might be the indicators to influence the occurrence of inability to urinate after TURP in BOO/DU patients. Compared to the patients of BPH without detrusor underactivity, the TURP on the patients with BPH associated with BOO and DU only extended the placement of the urille tube, but no improvement in the Mieturition function oi＂ the QOL.

关 键 词：经尿道前列腺电切 前列腺增生 逼尿肌功能减弱 膀胱出口梗阻 

分 类 号：R699[医药卫生—泌尿科学]