术前流行病学因素对良性前列腺增生患者手术疗效的影响  

Effects of preoperative epidemiological factors on the surgical outcomes of benign prostatic hyperplasia

作　　者：杨继尧 詹辉[1] 王剑松[1] 陈戬[1] 马晓涛 YANG Jiyao;ZHAN Hui;WANG Jiansong;CHEN Jian;MA Xiaotao(Department of Urology,The Second Affiliated Hospital of Kunming Medical University,Kunming 650000,China)

机构地区：[1]昆明医科大学第二附属医院泌尿外科,云南昆明650000

出　　处：《现代泌尿外科杂志》2023年第8期659-664,669,共7页Journal of Modern Urology

基　　金：云南省医学学科带头人培养计划项目(No.D-2018038);昆明医科大学联合专项面上项目(No.202101AY070001-153)。

摘　　要：目的 探讨影响良性前列腺增生症(BPH)患者行经尿道前列腺切除术(TURP)手术疗效的术前流行病学影响因素,并评价其临床预测价值。方法 收集2018年12月-2021年9月于昆明医科大学第二附属医院泌尿外科行TURP且术后病理检查提示BPH的患者。术前所有患者均已完成临床资料收集,包括国际前列腺症状评分(IPSS)、生活质量(QoL)评分、膀胱过度活动(OAB)评分、前列腺特异性抗原(PSA)测定、泌尿系超声等,并在术后对所有患者进行电话或面对面随访。随访内容包括术后患者IPSS评分、QoL评分、OAB评分等。根据疗效评判标准,将患者分为有效组和无效组。通过单因素分析得到影响TURP手术疗效的流行病学因素,采用二元logistic回归筛选影响手术疗效的独立影响因素,并使用受试者工作特征(ROC)曲线评价各独立影响因素的诊断价值。结果 OAB评分(OR=0.749,95%CI:0.627~0.895,P=0.001)、排尿期与储尿期IPSS评分比值(IPSS-V/S)(OR=4.919,95%CI:1.617~14.963,P=0.005)、尿潴留史(OR=7.513,95%CI:2.289~24.656,P=0.001)、尿失禁史(OR=2.656,95%CI:1.015~6.950,P=0.047)是术后疗效不佳的独立影响因素。分别绘制ROC曲线发现,OAB评分AUC=0.784(95%CI:0.718~0.841)、IPSS-V/S AUC=0.686(95%CI:0.614~0.751)、尿潴留史AUC=0.713(95%CI:0.643~0.777)、尿失禁史AUC=0.723(95%CI:0.654~0.786)。根据回归模型绘制ROC曲线,回归模型AUC=0.888(95%CI:0.834~0.930),其敏感性和特异性分别为93.53%和67.35%。结论 术前OAB评分、IPSS-V/S、尿潴留史、尿失禁史是BPH患者行TURP术后疗效不佳的流行病学独立影响因素。诊断效能从高到低分别为:回归模型>OAB评分>尿失禁史>尿潴留史>IPSS-V/S。以回归模型预测BPH患者行TURP的手术疗效的敏感性和特异性均较高,值得临床推广应用。Objective To investigate the preoperative epidemiological factors affecting the surgical outcomes of transurethral resection of the prostate(TURP)in patients with benign prostatic hyperplasia(BPH)and to evaluate the clinical predictive value.Methods Patients undergoing TURP at our hospital during Dec.2018 and Sep.2021 whose pathological examination suggestive of BPH were involved.Before operation,the clinical data,International Prostate Symptom Score(IPSS),quality of life(QoL)score,overactive bladder(OAB)score,prostate-specific antigen(PSA),and urological ultrasound results were collected.After operation,all patients were followed up with telephone call or face-to-face interview,and the IPSS,QoL score and OAB score were examined.Patients were divided into effective and ineffective groups according to the efficacy rubrics.The epidemiological factors affecting the efficacy of TURP were identified with univariate analysis,the independent influencing factors were screened with binary logistic regression,and the diagnostic value of each independent influencing factor was evaluated using receiver operating characteristic(ROC)curve.Results OAB score(OR=0.749,95%CI:0.627-0.895,P=0.001),IPSS-V/S(OR=4.919,95%CI:1.617-14.963,P=0.005),history of urinary retention(OR=7.513,95%CI:2.289-24.656,P=0.001),and history of urinary incontinence(OR=2.656,95%CI:1.015-6.950,P=0.047)were independent influencing factors for poor postoperative outcomes.ROC curve revealed that the area under the ROC curve(AUC)showed that AUC of OAB score,IPSS-V/S,history of urinary retention,and history of urinary incontinence were 0.784(95%CI:0.718-0.841),0.686(95%CI:0.614-0.751),0.713(95%CI:0.643-0.777),and 0.723(95%CI:0.654-0.786),respectively.ROC curve of the regression model showed that the AUC was 0.888(95%CI:0.834-0.930),and the sensitivity and specificity were 93.53%and 67.35%,respectively.Conclusion Preoperative OAB score,IPSS-V/S,history of urinary retention,and history of urinary incontinence were independent epidemiological factors of poor outcom

关 键 词：良性前列腺增生 经尿道前列腺电切术 手术疗效 流行病学因素 

分 类 号：R699[医药卫生—泌尿科学]