前列腺增生合并组织学前列腺炎患者的临床特征及术后并发症分析  

Clinical features and postoperative complications of patients with benign prostatic hyperplasia complicated with histological prostatitis

作　　者：杜国伟 熊晶 陈赵 陈洪波 却晖 郑江[5] 姚启盛[6] 耿杰[7] 贺大林[8] 王行环[1] 刘同族[1] DU Guo-wei;XIONG Jing;CHEN Zhao;CHEN Hong-bo;QUE Hui;ZHENG Jiang;YAO Qi-sheng;GENG Jie;HE Da-lin;WANG Xing-huan;LIU Tong-zu(Department of Urology,Zhongnan Hospital of Wuhan University,Wuhan 430071;Department of Urology,Chongqing People's Hospital,Chongqing 404100;Department of Urology,The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture,Enshi 445099;Department of Urology,Huanggang Central Hospital,Huanggang 438000;Department of Urology,Jingzhou First People's Hospital,Jingzhou 434000;Department of Urology,Shiyan Taihe Hospital,Shiyan 442008;Department of Urology,Suizhou Central Hospital,Suizhou 441300;Department of Urology,First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]武汉大学中南医院泌尿外科,湖北武汉430071 [2]重庆市人民医院泌尿外科,重庆404100 [3]恩施土家族苗族自治州中心医院泌尿外科,湖北恩施445099 [4]黄冈市中心医院泌尿外科,湖北黄冈438000 [5]荆州市第一人民医院泌尿外科,湖北荆州434000 [6]十堰市太和医院泌尿外科,湖北十堰442008 [7]随州市中心医院泌尿外科,湖北随州441300 [8]西安交通大学第一附属医院泌尿外科,陕西西安710061

出　　处：《现代泌尿外科杂志》2020年第7期596-600,共5页Journal of Modern Urology

基　　金：国家重点研发计划项目(No.2016YFC0106305);湖北省科技厅技术创新专项重大项目基金(No.2016ACA152)。

摘　　要：目的分析合并组织学前列腺炎的良性前列腺增生(BPH)患者的临床特征及经尿道前列腺等离子双极电切术后并发症。方法选取多中心2016年12月至2018年8月接受经尿道前列腺等离子双极电切手术的638例病例进行回顾性分析。根据病检结果分为单纯性前列腺增生组(增生组)和前列腺增生合并组织学前列腺炎组(增生伴炎症组)。比较两组的年龄、病检结果、体质指数、前列腺体积、最大尿流率(Qmax)、残余尿量(PVR)、血清前列腺特异性抗原(PSA)、国际前列腺症状评分(IPSS)、生活质量指数评分(QOL)、术后并发症,随访术后3个月患者的IPSS及QOL。结果638例BPH患者中,合并组织学前列腺炎218例,检出率为34.2%,其中患者术前最大尿流率、IPSS评分、IPSS-V、IPSS-S、QOL评分两组间差异有统计学意义(P<0.05);年龄、体质指数、前列腺体积、残余尿量、总前列腺特异抗原(T-PSA)、游离前列腺特异抗原(F-PSA)、游离前列腺特异抗原与总前列腺特异抗原比值(F-PSA/T-PSA)两组间比较无统计学差异(P>0.05);两组术后IPSS、IPSS-S、IPSS-V、QOL评分均较术前显著下降(P<0.001);术后IPSS-S增生伴炎症组较增生组高,说明增生伴炎症组储尿期症状改善较差(P=0.021);另外,术后并发症发生率增生组为8.3%,增生伴炎症组为13.8%,差异有统计学意义(χ^2=4.621,P<0.05),其中增生伴炎症组术后膀胱痉挛发生率5.05%显著高于增生组0.95%(χ^2=10.475,P=0.001)。结论合并组织学前列腺炎会加重下尿路症状,对BPH疾病的进展具有促进作用,术后储尿期症状改善没有单纯性前列腺增生患者明显,合并组织学前列腺炎会增加术后并发症的发生,因此在防治BPH的过程中,应注意前列腺炎症性改变,防止术后并发症的发生。Objective To investigate the clinical features and postoperative complications of patients with benign prostate hyperplasia(BPH)complicated with histological prostatitis(HP)undergoing transurethral plasma kinetic resection of prostate(PKRP).Methods In this multi-center cohort study,a retrospective analysis was performed on 638 patients who underwent PKRP during Dec.2016 and Aug.2018.According to the examination results,the patients were divided into two groups:simple BPH group(group A)and BPH plus HP group(group B).Patients'age,medical examination results,body mass index(BMI),prostate volume,maximum urine flow rate(Qmax),residual urine volume(PVR),serum prostate specific antigen(PSA),international prostate symptom score(IPSS),quality of life(QOL)and postoperative complications were compared between the two groups.Results There were 420 patients in group A and 218(34.2%)in group B.There were significant differences in Qmax,IPSS and QOL between the two groups(P<0.05),while there were no significant differences in age,BMI,prostate volume,PVR,T-PSA,F-PSA and F-PSA/T-PSA(P>0.05).There were significant differences in IPSS,IPSS-S,IPSS-V and QOL before and after surgery in both groups(P<0.001).The incidence of postoperative complications was 8.3%in group A and 13.8%in group B(χ^2=4.621,P<0.05).Group A had higher incidence of fever(2.86%)while group B had higher incidence of bladder spasm(5.05%).Conclusion HP aggravates symptoms of lower urinary tract and promotes progression of BPH.The improvement of postoperative urinary symptoms is not obvious in patients with BPH plus HP.In the management of BPH,attention should be paid to the inflammatory changes of the prostate to prevent postoperative complications.

关 键 词：组织学前列腺炎 前列腺增生 经尿道前列腺等离子双极电切术 术后并发症 

分 类 号：R737.14[医药卫生—肿瘤]