超选择性前列腺动脉栓塞术治疗前列腺增生的临床评价  

The evaluation of super-selective prostatic arterial embolization in the treatment of benign prostatic hyperplasia

作　　者：邱志磊[1] 王荃[1] 程楷[1] 苏道胜 梁鑫[1] 祝海[1] 高健刚[1] 

机构地区：[1]青岛市市立医院东院泌尿外科,266071

出　　处：《中华泌尿外科杂志》2016年第10期758-761,共4页Chinese Journal of Urology

基　　金：青岛市医药科研指导计划（2015-WJZD002）

摘　　要：目的 探讨超选择性前列腺动脉栓塞术（prostatic arterial embolization,PAE）治疗前列腺增生的临床疗效.方法 选取2012年2月至2015年3月确诊为前列腺增生且药物治疗无效、不愿或无法耐受手术的17例患者作为研究组.年龄61 ～ 84岁,平均73岁.前列腺体积（prostaticvolume,PV）平均（64.6±10.2） ml.国际前列腺症状评分（IPSS）平均（23.9±4.9）分,生活质量（QOL）评分平均（4.1±0.7）分,最大尿流率（Qmax）平均（9.5±3.7） ml/s.研究组行超选择性前列腺动脉栓塞术.在局麻下选择股动脉为穿刺点,X线监视下用F4～5 Cobra导管进入双侧髂内动脉造影显示前列腺主供血动脉后,将导管选择进入该血管并置入Embosphere栓塞微球.选择同期行经尿道前列腺电切术的前列腺增生患者40例作为对照组.年龄59 ～ 87岁,平均70岁.PV平均（68.7±9.2）ml,IPSS平均（24.5±4.5）分,QOL评分平均（4.1±0.6）分,Qmax平均（9.4 ±3.1）ml/s.比较两组患者手术前后PV、IPSS、QOL、Qmax的变化情况.结果 研究组17例术后PV为（42.0±7.5） ml,IPSS为（13.1±3.5）分、QOL评分为（2.1±0.7）分,Qmax为（21.8±4.2） ml/s;对照组术后PV为（32.9 ±4.6）ml,IPSS评分为（10.2±4.5）分,QOL评分为（1.7±0.6）分,Qmax为（24.3±3.7）ml/s,与术前比较差异均有统计学意义（P＜0.05）.对照组各项指标的变化幅度明显大于研究组,差异有统计学意义（P＜0.05）.结论 PAE治疗前列腺增生安全、有效,尤其适用于内科保守治疗无效、不愿或无法耐受外科手术的患者.Objective To evaluate the clinical efficacy of super-selective prostatic arterial embolization（PAE） for the treatment of benign prostatic hyperplasia（BPH）.Methods From February 2012to March 2015,a total of 17 patients with BPH who failed in medical treatment,or unwilling to accept surgery were selected for PAE as the study group.The mean age was 73 years （range 61-84 years） and the mean prostatic volume was 64.6 ml （ranging 50-85 ml）.The study group underwent super selective arterial embolization.The internal iliac artery angiography was performed and the main blood vessel of prostate was showed.The femoral artery was punctured under local anesthesia and X-ray monitoring,a F4-5 Cobra catheter was inserted,and then the Embosphere microspheres were implanted.A total of 40 patients who underwent transurethral resection of the prostate（TURP） were selected as the control group.The mean age was 70 years （ranging 59-87 years）.The mean prostatic volume was 68.7 ml（ranging 55-90 ml）.All cases were followed up for 1 year.The changes of prostatic volume （PV）,international prostate symptom score（IPSS）,quality of life （QOL）,pre-and post-treatment peak urinary flow （Qmax） were evaluated.Results For the 17 patients who underwent PAE,the PV decreased from （64.6 ± 10.2） ml to（42.0 ± 7.5） ml,the IPSS decreased from 23.9 ±4.9 to 13.1 ±3.5,QOL decreased from 4.1 ±0.7 to 2.1 ±0.7,and Q increased from （9.5 ± 3.7） ml/s to（21.8 ± 4.2） ml/s,which were statistically significant （P 〈 0.05） compared with the pre-treatment parameters.The post-operative parameters of the control group were also significantly improved compared with the preoperative parameters （P 〈 0.05）.Conclusions PAE is safe and effective in treating BPH,especially for those failing in medical treatment,or unwilling to accept surgery.

关 键 词：良性前列腺增生 前列腺动脉 介入栓塞 

分 类 号：R699.8[医药卫生—泌尿科学]