超选择性前列腺动脉栓塞术治疗巨大前列腺增生所致下尿路阻塞的价值  

Safety and effectiveness of prostatic arterial embolization for the treatment of benign prostatic hyperplasia

作　　者：袁冰 张金龙[2] 袁凯[1] 张国栋[1] 阎洁羽[1] 王茂强[1] 

机构地区：[1]解放军总医院介入放射科,北京100853 [2]南开大学医学院

出　　处：《中华放射学杂志》2018年第3期223-227,共5页Chinese Journal of Radiology

基　　金：国家自然科学基金（81471769）;中央保健科研课题（2013BJ09）

摘　　要：目的 探讨超选择性前列腺动脉栓塞术（PAE）治疗巨大良性前列腺增生（BPH）导致下尿路阻塞患者的安全性及有效性。方法 前瞻性纳入2010年1月至2013年12月解放军总医院确诊为BPH导致的严重下尿路阻塞，前列腺体积（PV）大于80 ml，经药物治疗6个月以上无效且不适合行外科手术治疗的64例患者。行前列腺动脉（PA）造影，采用＂二步栓塞法＂联合应用50 μm和100 μm的聚乙烯醇颗粒进行PA栓塞（PAE）。术后1、3、6个月分别评估国际前列腺症状评分（IPSS）、生活质量评分（QoL）、最大尿流率（Qmax）、残余尿量（PVR）、国际勃起功能评分（IIEF-5）、前列腺特异性抗原（PSA）和PV，此后每6个月评估1次。采用配对样本t检验比较术后各时间点和术前这些指标的差异。结果 64例中，60例（93.8%）成功行PAE，PAE术后1、3、6、12和24个月临床有效率分别为95.0%（57/60）、95.0%（57/60）、93.3%（56/60）、92.6%（50/54）和90.5%（38/42）。42例PAE术后随访2年，术后24个月的IPSS、QoL、PV、Qmax、PVR与术前差异均有统计学意义（P均〈0.05），IIEF-5评分差异无统计学意义（P〉0.05）。PAE术后24 h，血清PSA升高至术前的20.7（78.5/3.8）倍，术后1周较术后24 h下降，但仍为术前的9.1（34.5/3.8）倍，术后1个月降至术前水平，术后3个月以后均低于术前水平，差异有统计学意义（P均〈0.05）。PAE术后均未出现严重并发症。结论 PAE治疗巨大BPH所致的下尿路阻塞安全、有效。Objective To evaluate the effectiveness and safety of prostatic arterial embolization as a primary treatment for patients with lower urinary tract symptoms as a result of large benign prostatic hyperplasia.Methods This was a prospective, single-center study enrolling 64 patients with prostates〉80 ml from January 2010 to December 2013. Prostatic arterial embolization was carried out using a combination of 50 μm and 100 μm particles. Clinical follow up was carried out using the International Prostate Symptom Score, quality of life, peak urinary flow, postvoid residual volume, International Index of Erectile Function Short Form, prostate-specific antigen, and prostatic volume at 1, 3, 6 month following embolization, the parameters were compared by using t test.Results Prostatic arterial embolization was technically successful in 60 of 64 patients （93.8%）. Follow-up data were available for 60 patients with a mean of 18 months, a total of 42 patients had completed the follow up at 24 months after prostatic arterial embolization. A clinical improvement, defined as reduction of International Prostate Symptom Score and increase of peak urinary flow, at 1 month, 3 months, 6 months, 12 months and 24 months, was achieved in 95.0% （57/60）, 95.0% （57/60）,93.3% （56/60）,92.6% （50/54） and 90.5% （38/42）, respectively. There was an improvement in terms of mean International Prostate Symptom Score, mean quality of life, mean peak urinary flow, mean post-void residual volume and prostatic volume were significantly different with respect to baseline（all P〈0.05）. No serious complications occurred.Conclusion Prostatic arterial embolization appears to be a safe and effective treatment method for patients with lower urinary tract symptoms as a result of large benign prostatic hyperplasia.

关 键 词：前列腺增生 血管造影术 数字减影 前列腺动脉栓塞术 下尿路阻塞 

分 类 号：R699.8[医药卫生—泌尿科学]