刁英智 任向宏张明华 蒙学兵 谷亚明 刘红雷 郭应禄
【摘要】目的 探讨经直肠超声引导下前列腺水囊扩开术(transurethral balloondilation of the prostate, TUDP)治疗良性前列腺增生(benign prostatic hyperplasia, BPH)的有效性及安全性。方法 回顾性分析2011年11月至2012年11月，23例经直肠超声引导下TUDP治疗的BPH患者的临床资料，其中16例术前留置导尿。内囊扩张前列腺尖部及膜部尿道，外囊扩张前列腺部尿道及膀胱颈。随访患者术后1、3、6、12个月的主观指标(IPSS评分、QOL评分)及客观指标(最大尿流率、残余尿量)等。结果 手术时间30～165分钟，术中出血5～50ml；术后1、3、6、12个月的IPSS评分分别为(10.4±4.2)、(8.7±3.2)、(9.5±4.6)、(8.3±1.5)分，与术前(22.0±7.2)分比较差异均有统计学意义(P<0.05)；QOL评分分别为(2.1±1.1)、(1.6±1.0)、(1.8±1.1)、(1.6±1.0)分，与术前(4.9±0.9)分比较差异均有统计学意义(P<0.05)；Qmax分别为(10.5±3.4)、(12.4±4.2 )、(10.9±3.9 )、(12.7±4.6) ml/s，与术前(1.9±1.9)ml/s比较差异均有统计学意义(P<0.05)。术后1、2、3个月分别发生尿失禁5、4、2例，但术后4个月无尿失禁。术后发生附睾炎3例。结论 经直肠超声引导下TUDP治疗BPH安全、有效，费用低廉，尤其适合基层医院开展。
基金项目：首都临床特色应用研究(Z121107001012156)
作者单位：101500 北京，首都医科大学密云教学医院泌尿外科(刁英智、任向宏、张明华、蒙学兵、谷亚明、刘红雷)；北京大学第一医院泌尿外科(郭应禄)
通信作者：刁英智，Email：diaoyingzhimy@163.com
关键词 超声引导下 前列腺水囊扩开术
One year therapeuticeffect analysis of ultrasound guided TUDP for BPH Diao Yingzhi , Ren Xianghong , Zhang Minghua, Meng Xuebing , Gu Yaming , Liu Honglei , Guo Yinglu . Department of Urology, Miyun TeachingHospital, Capital Medical University, Beijing 101500, China Correspondingauthor:Diao Yingzhi,Email:diaoyingzhimy@163.com
[Abstract] Objective This study wasto investigate the efficacy and safety of transrectal ultrasound guidedtransurethral balloon dilation of the prostate (TUDP) for benign prostatichyperplasia (BPH). Medthod A total of 23 men with BPH who had undergone TUDPwere retrospective analyzed, including 16 men with indwelling urinary cathetersbefore the operation. During the TUDP, the prostatic apex and membranousurethra were dilated by inner balloon, and the prostatic urethra and bladderneck were dilated by outer balloon. The patients were followed up at the 1st ,2nd, 6th and 12th month after the operation, and the observation indexesinclude subjective indexes, such as international prostatic symptom score(IPSS) and quality of life (QOL) score, and objective indexes, such as maximumflow rate (Qmax) and post-void residual (PVR). Results The average operationtime was 30-165min, and the average intraoperative hemorrhage volume was5-50ml. The IPSS scores at 1st , 2nd, 6th and 12th month after the operationwere10.4?.2, 8.7?.2, 9.5?.6 and8.3?.5 respectively,which were significantlydecreased in comparison to the IPSS score
(22.0?.2) before the operation (p 0.05). The QOL scores at 1st , 2nd,6th and 12th month after the operation were 2.1?.1, 1.6?.0, 1.8?.1 and 1.6?.0respectively, which were significantly increased in comparison to the QOL score(4.9?.9) before the operation (p 0.05). The Qmax at 1st , 2nd, 6th and 12thmonth after the operation were 10.5?.4, 12.4?.2, 10.9?.9 and 12.7?.6 ml/srespectively, which were significantly increased in comparison to the Qmax(1.9?.9 ml/s) before the operation (p 0.05). There were 5, 4, 2 cases ofurinary incontinence at the 1st, 2nd and 3rd month after the operation, butthey recovered at the 4th month after the operation. Besides, there were 3cases of epididymitis. Conclusions Transrectal ultrasound guided TUDP is asafe, effective and low cost option for the treatment of BPH, especially forthe primary hospitals。
[Key words]
Ultrasound guided; Transurethral balloon dilatation ofthe prostate
良性前列腺增生(benignprostatic hyperplasia, BPH)是威胁老年男性的一种常见病及多发病，随着老龄化进程的加快，就诊患者高龄化及其伴随疾病逐渐增多，临床上需要一种风险小、操作简单的治疗方法来治疗高风险的BPH患者。我国学者姜汉胜等[1]采用前列腺水囊扩开术(transurethralballoon dilation of the prostate, TUDP)治疗BPH，取得了较好的临床效果。但由于操作完全凭经验完成，有时难以达到确切的效果。我们采用经直肠超声引导下TUDP治疗BPH，插入扩张导管后，在超声的引导下内囊扩开前列腺尖部及膜部尿道，外囊扩开前列腺部尿道及膀胱颈，操作简单，手术时间短，风险小。2011年11月至2012年11月我院采用经直肠超声引导下TUDP治疗BPH患者23例，并进行短期随访，效果满意。现报告如下。
对象与方法
一、一般资料
本组23例患者，年龄65～85岁，平均75岁；术前IPSS评分8～32(22.0±7.2)分；QOL评分3～6(4.9±0.9)分；Qmax0～5(1.9±1.9)ml/s；术前16例留置尿管，余7例残余尿量0ml；经直肠超声检查测定前列腺体积20～154(55.3±30.1)ml。
术前留置导尿16例，合并膀胱结石2例，合并腹股沟疝2例，继发上尿路积水4例，肾功能不全4例，术前伴有心脏疾病4例，呼吸系统疾病2例，脑血管疾病4例，糖尿病4例，高血压4例，恶性肿瘤术后2例，双下肢瘫痪4例。
入选标准：①尿动力学检查明确为膀胱出口梗阻；②IPSS评分8分以上，QOL评分3分以上；③除外前列腺癌、前列腺手术史及尿道狭窄；④无严重的心肺功能障碍、出血性疾病及精神障碍，无不能合作性疾病；⑤可取截石位；⑥前列腺体积暂不做限定。
