内镜辅助下经尿道柱状水囊前列腺扩开术治疗高龄高危良性前列腺增生疗效观察  

Effect of endoscope-assisted transurethral columnar balloon dilation of the prostate in the treatment of high-risk elderly patients with benign prostatic hyperplasia

作　　者：杨晓亮[1] 范毛川[2] 魏灿[1] 张艳斌[1] 席俊华[1] 王伟[1] 吴畏[1] 杨振兴[1] 井俊峰 齐伟[1] 陈华国[3] YANG Xiaoliang;FAN Maochuan;WEI Can;ZHANG Yanbin;XI Junhua;WANG Wei;WU Wei;YANG Zhenxing;JIN Junfeng;QI Wei;CHEN Huaguo(Department of Urology,the Second People′s Hospital of Hefei,Hefei 230011,Anhui Province,China;Department of Urology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;Department of Emergency,the Tenth People′s Hospital of Shanghai Affiliated to Tongji University,Shanghai 200072,China)

机构地区：[1]合肥市第二人民医院泌尿外科,安徽合肥230011 [2]新乡医学院第一附属医院泌尿外科,河南卫辉453100 [3]同济大学附属上海市第十人民医院急诊科,上海200072

出　　处：《新乡医学院学报》2020年第6期570-573,579,共5页Journal of Xinxiang Medical University

基　　金：安徽省科技厅科技攻关项目(编号:1501Id04056);合肥市卫计委应用医学研究重点项目(编号:hwk2018zd003)。

摘　　要：目的探讨内镜辅助下经尿道柱状水囊前列腺扩开术(EA-TUCBDP)治疗高龄高危良性前列腺增生(BPH)的临床疗效与安全性。方法回顾性分析2016年11月至2019年8月合肥市第二人民医院收治的31例高龄高危BPH患者的临床资料,所有患者行EA-TUCBDP治疗,分别于手术前和术后3个月对患者进行国际前列腺症状评分(IPSS)和生活质量(QOL)评分,应用尿流率检测仪检测最大尿流率(Qmax),应用经腹超声检测排泄后残留尿量(PVR),并检测患者血清前列腺特异性抗原(PSA)水平;记录患者扩裂手术时间、术中出血量、持续膀胱冲洗时间、术后尿管留置时间、术后住院时间及围术期并发症;所有患者术后随访3~24个月,观察并发症发生情况。结果 31例患者均成功完成手术,扩裂手术时间(41.65±14.30) min,术中出血量(9.19±16.34) m L,持续膀胱冲洗时间(2.00±0.73) d,术后导尿管留置时间(6.94±1.67) d,术后住院时间(10.19±3.96) d。2例术后出血患者采用尿管牵引压迫、药物止血治疗后缓解;拔管后暂时性尿失禁3例,症状均在2周内消失;术后发热1例,给予敏感抗生素治疗后热退。与术前比较,术后3个月患者IPSS评分、QOL评分、PVR显著降低,Qmax显著升高(P <0.05);术后3个月患者血清PSA水平与术前比较差异无统计学意义(P> 0.05)。1例患者术后出现逆行射精,术后6个月症状自行缓解;其他患者无并发症发生。结论 EA-TUCBDP治疗BPH安全、有效,具有操作简便、学习曲线短、手术时间短、手术创伤小、术后并发症少、复发率低等优点。Objective To investigate the clinical effect and safety of endoscope-assisted transurethral columnar balloon dilation of the prostate(EA-TUCBDP)in the treatment of high-risk elderly patients with benign prostatic hyperplasia(BPH).Methods The clinical data of 31 high-risk elderly patients with BPH admitted to the Second People′s Hospital of Hefei from November 2016 to August 2019 were analyzed retrospectively.All patients were treated with EA-TUCBDP.Before and three months after operation,the patients were assessed with international prostate symptom score(IPSS)and quality of life(QOL)score,the maximum urine flow rate(Qmax)was measured by uroflowmetry,the postvoid residual(PVR)was measured by transabdominal ultrasound,and the serum prostate specific antigen(PSA)level was measured.The operation time,intraoperative bleeding volume,continuous bladder irrigation time,postoperative catheter retention time,postoperative hospitalization time and perioperative complications were recorded.All patients were followed up for 3-24 months after operation to observe the complications.Results The operation was successfully completed in 31 patients.The operation time,intraoperative bleeding volume,continuous bladder irrigation time,catheter retention time and the postoperative hospitalization time were(41.65±4.30)min,(9.19±16.34)mL,(2.00±0.73)d,(6.94±1.67)d and(10.19±3.96)d.The two patients with postoperative bleeding were relieved after the treatment of urinary tube compression and drug hemostasis.The symptoms of three cases of temporary urinary incontinence disappeared within two weeks after extubation.The temperature of one patient with postoperative fever recovered after sensitive antibiotic treatment.Compared with before operation,the IPSS score,QOL score and PVR decreased significantly,and the Qmax increased significantly(P<0.05).There was no significant difference in serum PSA level between the three months after operation and before operation(P>0.05).The retrograde ejaculation occurred in one patients,and the sympto

关 键 词：良性前列腺增生 高危患者 经尿道柱状水囊前列腺扩开术 内镜 

分 类 号：R697.3[医药卫生—泌尿科学]