基于MRI多参数评价激光剜除治疗中重度良性前列腺增生的临床疗效  

Evaluation of clinical efficacy of laser enucleation for moderate to severe benign prostatic hyperplasia through MRI multi-parameters

作　　者：陈君 何桂兵 方萍 CHEN Jun;HE Guibing;FANG Ping(Department of Radiology,Jinhua People's Hospital,Jin-hua 321000,China)

机构地区：[1]金华市人民医院放射科,浙江金华321000 [2]金华市人民医院泌尿外科,浙江金华321000 [3]金华市金东区中医院放射科

出　　处：《全科医学临床与教育》2023年第7期588-592,共5页Clinical Education of General Practice

基　　金：金华市科技计划项目(2021-4-069)。

摘　　要：目的基于MRI多参数评价激光剜除治疗中重度良性前列腺增生(BPH)的临床疗效。方法选取中重度BPH患者144例,均接受超声引导下经尿道激光剜除术,于术前、术后1个月和6个月采用1.5T对比增强MRI序列(包括T1WI、T2WI和DWI)评价前列腺体积、激光剜除面积、针迹可视化、尿道周围水肿、腔隙和尿道形态保存,比较血清前列腺特异性抗原(PSA)、尿动力学最大尿流率(Qmax)和排泄后残留尿量(PVR)、国际前列腺症状评分(IPSS)和国际生活质量(I-QoL)评分,使用Clavien Dindo量表评估不良事件。结果手术前后患者血清PSA水平无明显变化(F=0.56,P>0.05)。术后1个月和6个月患者Qmax和I-QoL评分较术前明显升高,PVR和IPSS评分较术前明显下降(LSD-t分别=5.63、3.65;33.32、19.65;22.30、11.21;42.32、89.63,P均<0.05)。术后1个月和6个月MRI显示前列腺体积比术前明显缩小,术后6个月剜除面积比术后1个月明显缩小,针迹可视化率、水肿率和腔隙率明显下降(t=102.32,χ^(2)分别=148.56、184.11、120.60,P均<0.05),尿道形态保存率与术前相比无明显变化(χ^(2)=0.68,P>0.05)。随访6个月无严重不良事件发生。结论对比增强MRI多个序列能够定量和定性评价激光剜除治疗中重度BPH的临床疗效,有较好的应用价值。Objective To evaluate the clinical efficacy of laser enucleation for moderate to severe benign prostatic hyperplasia(BPH)based on MRI multi-parameters.Methods Totally 144 patients with moderate to severe BPH were enrolled.Transurethral laser enucleation under the guidance of ultrasound was performed.Before operation,1 month and 6 months after operation,1.5T contrast-enhanced MRI sequences(including T1WI,T2WI and DWI)was used to evaluate prostate volume,laser ablation area,needle track visualization,periurethral edema,cavity and urethral shape preservation,serum prostate specific antigen(PSA),urodynamics[Qmax and postvoid residual(PVR)].The IPSS and international quality of life(I-QoL)scores were compared,and Clavien-Dindo scale was used to evaluate adverse events.Results There was no differences of serum PSA level before and after operation(F=0.56,P>0.05).Qmax and I-QoL score at 1 month and 6 months after operation increased significantly,PVR and IPSS score decreased significantly when compared to that before operation(LSD-t=5.63,3.65,33.32,19.65,22.30,11.21,42.32,89.63,P<0.05).MRI at 1 month and 6 months after operation showed that prostate volume was significantly smaller than that before operation,ablation area at 6 months after operation was significantly smaller than that at 1 month after operation,what’s more,the rates of needle track visualization,edema and cavity were significantly less(t=102.32,χ^(2)=148.56,184.11,120.60,P<0.05),but the rate of urethral shape preservation did not change compared with that before operation(χ^(2)=0.68,P>0.05).There was no serious adverse event in the follow-up of 6 months.Conclusion Multiple sequences of contrast-enhanced MRI can quantitatively and qualitatively evaluate the clinical efficacy of laser enucleation in the treatment of moderate to severe BPH,which has good application value.

关 键 词：对比增强MRI 激光剜除 良性前列腺增生 国际前列腺症状评分 尿动力学 

分 类 号：R699.8[医药卫生—泌尿科学] R445.2[医药卫生—外科学]