经尿道柱状水囊前列腺扩开术治疗小体积前列腺增生的临床疗效研究  

Clinical efficacy study of transurethral columnar balloon dilation of the prostate in the treatment of small volume benign prostate hyperplasia

作　　者：杨鹏[1] 吕蔡[1] 张冲[1] 文礼 刘振湘[1] Yang Peng;Lyu Cai;Zhang Chong;Wen Li;Liu Zhenxiang(Department of Urology,Central South University Xiangya School of Medicine Affiliated Haikou Hospital,Haikou 570000,China)

机构地区：[1]中南大学湘雅医学院附属海口医院泌尿外科,海口570000

出　　处：《国际泌尿系统杂志》2024年第4期657-661,共5页International Journal of Urology and Nephrology

基　　金：海南省自然科学基金项目(2021821MS0845)。

摘　　要：目的探讨经尿道柱状水囊前列腺扩开术治疗小体积良性前列腺增生(BPH)的临床疗效及安全性。方法回顾性分析2020年1月至2021年12月在本院行经尿道柱状水囊前列腺扩开术治疗的40例小体积BPH患者的临床资料。术后随访1年,每3个月患者在门诊复查国际前列腺症状评分(IPSS)、生活质量(QOL)评分、最大尿流率(Q_(max))、膀胱残余尿量(PVR)、国际勃起功能障碍评分(IIEF-5)和勃起硬度评分(EHS)等指标,观察并分析患者治疗前后的指标变化和射精异常情况。结果所有患者均顺利完成手术,其中38例一次性扩裂成功,2例首次扩裂效果不理想立即行二次扩裂后达到满意效果。扩裂部位均位沿12点方向前列腺包膜裂开,扩裂充分深达脂肪层。术毕按压膀胱辅助排尿尿线较术前明显增粗,且射程变远。其手术时间为(20.34±5.6)min,术中出血量(15.5±6.4)mL,术后膀胱冲洗时间(10.6±2.4)h,术后留置尿管时间均为5 d,术后住院时间(5.5±1.5)d。术后患者的IPSS、QOL评分、Q_(max)、PVR均优于术前,差异均有统计学意义(均P<0.05)。存在性生活的35例患者术前、术后的IIEF-5、EHS比较,差异均无统计学意义(均P>0.05),其中有2例出现短暂性逆行射精。术后患者发生短暂性尿失禁6例,尿道外口狭窄2例,膀胱颈挛缩0例,术后出血2例,排尿困难2例,尿路感染4例,经短期对症治疗后均有好转。结论经尿道柱状水囊前列腺扩开术治疗小体积BPH的近期临床疗效显著,具有操作简单,手术时间短,并发症少等优点,尤其适合要求保留性功能的患者,术后尿道瘢痕狭窄和膀胱颈挛缩发生率低,值得临床进一步推广。Objective To explore the clinical efficacy and safety of transurethral columnar balloon dilation of the prostate in the treatment of small volume benign prostatic hyperplasia(BPH).Methods We retrospectively analyzed the clinical and follow-up data on 40 cases of small volume BPH treated by transurethral columnar balloon dilation of the prostate from January 2020 to December 2021.The patients were followed up for 1 year after surgery.The international prostate symptom score(IPSS),quality of life(QOL)score,maximum urinary flow rate(Q_(max)),bladder residual urine volume(PVR),international erectile dysfunction score(IIEF-5)and erectile hardness score(EHS)were reviewed every 3 months in the outpatient department.The changes of indexes and abnormal ejaculation before and after treatment were observed and analyzed.Results All patients successfully completed the surgery,with 38 cases achieving successful dilation in one attempt and 2 cases requiring a second dilation to achieve satisfactory results due to initial suboptimal effects.The dilations were performed along the 12 o′clock direction,causing sufficient and deep expansion of the prostate capsule into the fatty layer.After the procedure,bladder compression was applied to assist with urination,resulting in a noticeable increase in urine flow rate and longer distance of projection compared to pre-surgery.The mean operation time of(20.34±5.6)min and the average intraoperative blood loss of(15.5±6.4)mL,postoperative bladder irrigation time was(10.6±2.4)hours,catheter indwelling time was 5 days for all patients,and the length of hospital stay was(5.5±1.5)days.The Q_(max),PVR,IPSS score and QOL score at 1,6 and 12 months after surgery were all better than those before surgery in the same group,and the differences were statistically significant(all P<0.05).Thirty-five of the patients with sexual life exhibited no significant difference from the baseline in IIEF-5 and EHS scores(all P>0.05),including two cases experienced transient retrograde ejaculation.Six cases of

关 键 词：前列腺增生 经尿道柱状水囊前列腺扩开术 尿道狭窄 痉挛 

分 类 号：R699.8[医药卫生—泌尿科学]