TURP联合膀胱造瘘治疗前列腺增生糖尿病患者伴逼尿肌收缩减弱的疗效观察  

Effect observation on TURP combined with cystostomy in treatment of BPH in diabetic patients accompanied with impaired detrusor contractility

作　　者：叶发根[1] 沈建强[1] 廖解志[1] 谢毓芳[1] 陈红[1] 杨荣华[1] 

机构地区：[1]浙江省湖州市中心医院泌尿外科,浙江湖州313000

出　　处：《中国现代医生》2017年第22期56-59,共4页China Modern Doctor

基　　金：浙江省湖州市公益性技术应用研究(2014GYB09)

摘　　要：目的 观察经尿道前列腺电切术(TURP)联合膀胱造瘘治疗前列腺增生伴逼尿肌收缩减弱糖尿病患者的手术疗效。方法选择42例前列腺增生伴逼尿肌收缩减弱糖尿病患者,按膀胱逼尿肌受损程度分为A组(Pdet21~39 cm H——2O)26例、B组(Pdet10~20 cm H——2O)16例。所有患者均在连硬膜外麻醉下进行经尿道前列腺电切联合膀胱造瘘术,术后半年行尿动力检查,并进行国际前列腺症状评分(IPSS)、生活质量评分(QOL)。结果 A组与B组术后在Qmax、RUV、IPSS、QOL方面均有明显改善,差异有统计学意义。A组最大Pdet术前、术后有统计学差异;B组最大Pdet术前、术后无统计学差异。A组总拔除膀胱造瘘管率为88.5%,B组总拔除造瘘管率为56.3%,两组总拔除造瘘管率为76.2%。A组与B组总拔除造瘘管率差异有统计学意义。结论逼尿肌损伤轻的患者术后逼尿肌收缩力有所恢复,建议对前列腺增生合并有逼尿肌损伤的糖尿病患者尽早手术。Objective To observe the surgical effect on TURP combined with cystostomy in treatment of BPH accom- panied with impaired detrusor contractility in diabetic patients. Methods A total of 42 diabetic patients with BPH ac- companied with impaired detrusor contractility were selected and divided into group A（Pdet21N39 cmH20, n=26） and group B （Pdet10-20 cmH20, n=16） based on the impairment of detrusor. All patients were given TURP combined with cystostomy under epidural anesthesia. Urodynamic examination was conducted half a year after surgery and the patients were scored by International prostate symptom score（IPSS） and Quality of Life score（QOL）. Results The Qmax, RUV, IPSS, and QOL were significantly improved in both groups after treatment. There was significant difference in maximum Pdet before and after surgery in groups A, which was not observed in group B. The overall removal rate of bladder stoma was 88.5% in group A, and 56.3% in group B, summing up as 76.2% in both groups, and there was significant difference in the removal rate of bladder stoma between two groups. Conclusion The detrusor contractility can recover in patients with mild impairment of detrusor, and early surgical treatment is recommended in diabetic patients with BPH accompanied with impaired detrusor contractility.

关 键 词：前列腺增生 糖尿病 逼尿肌减弱 经尿道前列腺电切术 尿动力学 

分 类 号：R697.32[医药卫生—泌尿科学]