“诊断性”前列腺电切术在前列腺穿刺活检阴性伴下尿路症状患者中的应用  

Application value of ＂diagnostic＂ transuretbral resection prostate in patients with negative prostate puncture biopsy combined with lower urinary tract symptoms

作　　者：胡志凯[1] 许露伟[1] 桂赞龙 徐郑[1] 贾瑞鹏[1] 吴剑平[1] 梁凯[1] 窦全亮[1] 

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)泌尿外科,210006

出　　处：《中华老年医学杂志》2017年第2期166-168,共3页Chinese Journal of Geriatrics

基　　金：国家自然科学基金资助项目（81070597）

摘　　要：目的探讨诊断性前列腺电切术（TURP）在合并中、重度下尿路症状（LUTS）前列腺穿刺活检阴性患者中的应用价值。方法选取2007年1月至2012年12月期间住院治疗的患者257例，入选标准：（1）年龄≥60岁；（2）血清PSA异常（PSA〉4．0μg／L）；（3）中、重度LUTS，国际前列腺症状评分（IPSS）均〉8分；（4）首次前列腺穿刺活检阴性。对上述患者行“诊断性”TURP。观察TURP术后病理诊断为良性前列腺增生（BPH）患者的血清PSA水平、IPSS等变化，探讨诊断性TURP在前列腺穿刺活检阴性、合并中、重度LUTS患者中的应用价值。结果257例初次活检阴性患者均行TURP，术后病理诊断BPH236例（91．8％），前列腺癌（PCa）21例（8．2％）。BPH组和PCa组年龄、前列腺体积、血清PSA、f／tPSA比较均无显著性差异均（P〈0．05）。术后随访5年-8年（平均6．2年），2例血清PSA升高，行2次前列腺穿刺活检确诊为PCa，余患者血清PSA水平和IPSS较术前水平明显下降，且长期维持在正常范围（P〈0．05）。结论对前列腺穿刺活检阴性且合并中、重度LUTS者，“诊断性”TURP可在改善LUTS的基础上，降低血清PSA水平，解除患者的心理负担。Objectives To evaluate the value and significance of diagnostic transurethral resection prostate（TURP）on patients with negative prostate puncture biopsy combined with lower urinary tract symptoms. Methods 257 patients over 60 years old from January 2007 to December 2012 were chosen with negative prostate puncture biopsy at first time with elevated PSA level（〉4 μg/ L）, medium and heavy lower urinary tract symptoms （International prostate symptom score （IPSS） 8. Diagnostic TUEP was used for these patients. According to pathological examination of prostate tissue removed in the surgery, the patients were divided into prostate carcinoma（‘ PCa’）group and benign prostate hypertrophy group. Serum PSA level and international prostate symptom score（IPSS） of patients with benign prostatic hyperplasia （BPH）were observed. Application value of diagnostic TUEP in patients with negative prostate biopsy combined with medium and heavy lower urinary tract symptoms was explored. Results The proportion of all pathological diagnosis accounted for 92% （236/257）by benign prostate hypertrophy, for 8% （21/257）by prostate carcinoma. The age, prostate volume,serum PSA and f/tPSA had no significant difference between the two groups（all P〉0.05） . We followed BPH patients for 5-8 years. 2 patients showed a persistently rising in PSA level and were diagnosed with PCa after 2 times the prostate biopsy. PSA levels and IPSS were significantly decreased and permanently sustained normalization after surgery for the other patients（P〈0.05）. Conclusions Diagnostic TURP can be used as a helpful method for patients with negative prostate puncture biopsy combined with lower urinary tract symptoms. It achieves the aim of normalizing PSA levels and removing the patient＇s psychological load.

关 键 词：诊断 前列腺切除术 下尿路症状 前列腺特异抗原 

分 类 号：R737.25[医药卫生—肿瘤]