分期治疗前列腺增生合并重度膀胱逼尿肌无力的疗效分析  

作　　者：何桂兵 黄益平 吴慧玲[1] 刘庆[1] 杜小文[1] 

机构地区：[1]浙江省金华市人民医院,321000

出　　处：《浙江临床医学》2022年第6期867-869,共3页Zhejiang Clinical Medical Journal

基　　金：金华市科学技术研究计划重点项目(2020-3-054)。

摘　　要：目的探讨前列腺增生合并重度膀胱逼尿肌无力(DU)的患者采用一期膀胱造瘘,二期行经尿道前列腺等离子双极剜除术(TUPEP)分期治疗的效果。方法回顾性分析前列腺增生合并重度DU患者42例,一期均行膀胱造瘘,根据逼尿肌收缩力恢复情况将患者分为恢复组(22例)和未恢复组(20例),恢复组在逼尿肌功能恢复后二期行前列腺等离子剜除手术。收集并比较治疗前、逼尿肌力恢复后和TUPEP术后12个月患者的最大尿流率(Qmax)、最大尿流率时的逼尿肌压力(Pdetmax)、逼尿肌收缩系数(DECO)、膀胱顺应性(BC)、国际前列腺症状评分(IPSS)、残余尿量(RV)等数据,并进行治疗效果评价。结果逼尿肌力恢复后与治疗前的Qmax、Pdetmax、DECO比较,差异有明显统计学意义(P<0.05)。术后12个月患者的Qmax、IPSS、排尿期IPSS、储尿期IPSS、RV与逼尿肌力恢复后和治疗前比较,差异均有统计学意义(P均<0.05)。结论重度DU的前列腺增生患者,先采用一期膀胱造瘘,待逼尿肌功能恢复后行二期TUPEP的疗效满意。Objective To investigate the effect of one-stage cystostomy and two-stage transurethral plasmakinetic enucleation of prostate(TUPEP)in patients with benign prostatic hyperplasia complicated with severe bladder detrusor weakness(DU).Methods Forty-two patients with BPH complicated with severe DU underwent cystostomy in the first stage.According to the recovery of detrusor contractility,the patients were divided into the recovery group(22 cases)and the non-recovery group(20 cases).The recovery group underwent plasma enucleation of prostate in the second stage after the recovery of detrusor function.The data of maximum flow rate(Qmax),detrusor pressure at maximum flow rate(Pdetmax),detrusor contraction coefficient(DECO),bladder compliance(BC),international prostate symptom score(IPSS)and residual urine volume(RV)were collected and compared before treatment,after recovery of detrusor strength and 12 months after TUPEP,and the therapeutic effect was evaluated.Results There were significant differences in Qmax,Pdetmax and DECO between the detrusor muscle strength after recovery and before treatment(P<0.05).There were significant differences in Qmax,IPSS,IPSS during urination,IPSS during urine storage and RV 12 months after operation compared with those after detrusor muscle strength recovery and before treatment(P<0.05).Conclusion For patients with benign prostatic hyperplasia with severe detrusor underactivity,one-stage cystostomy and twostage prostatectomy after the recovery of detrusor function is satisfactory.

关 键 词：前列腺增生 膀胱逼尿肌无力 膀胱造瘘术 经尿道前列腺等离子双极剜除术 

分 类 号：R69[医药卫生—泌尿科学]