保留前列腺尖部尿道黏膜的经尿道前列腺电切术改善良性前列腺增生术后尿失禁的临床研究
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摘要
目的:探讨保留前列腺尖部尿道黏膜的TURP应用于BPH的临床效果。方法:回顾性分析92例BPH患者临床资料,根据对前列腺尖部处理方式的不同分为两组,行常规TURP者纳入对照组(n=40),在TURP术中保留前列腺尖部尿道黏膜者纳入观察组(n=52),两组术后随访均≥6个月。分析两组围术期基本指标及术后6个月内并发症发生情况差异,观察术前及术后3、7 d时,两组尿液细胞因子[肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)]水平波动,比较术前及术后6个月时,两组尿动力学参数[最大尿流率(Qmax)、平均尿流率(Qave)、剩余尿量(RUV)]、逼尿肌功能[膀胱收缩指数(BCI)]、症状严重程度[国际前列腺症状评分(IPSS)]、生活质量[良性前列腺增生患者生活质量量表(BPHQLS)]变化。结果:术后6个月时,两组Qmax、Qave均明显高于术前水平,RUV均明显低于术前水平(P<0.05),而组间水平对比均差异无统计学意义(P>0.05);观察组BCI水平较术前无显著变化(P>0.05),但较同期对照组明显更高(P<0.05);两组IPSS评分均明显低于术前水平,且观察组较同期对照组明显更低(P<0.05);两组BPHQLS评分均明显低于术前水平,且观察组较同期对照组明显更高(P<0.05)。术后3、7 d时,两组尿液TNF-α均明显低于术前水平,且观察组较同期对照组明显更低(P<0.05),两组尿液TGF-β1均明显高于术前水平,且观察组较同期对照组明显更高(P<0.05)。组间腺体切除质量及手术时间比较均差异无统计学意义(P>0.05),而术中出血量、膀胱冲洗时间、导尿管留置时间、术后住院时间均明显少于对照组(P<0.05)。术后6个月内,两组反复血尿、尿路感染、膀胱损伤及逆行射精发生率比较均差异无统计学意义(P>0.05),而观察组压力性尿失禁、急迫性尿失禁发生率则均明显低于对照组(P<0.05)。结论:保留前列腺尖部尿道黏膜TURP与常规术式治疗BPH效果相当,且能降低尿失禁发生率,提高患者术后恢复效率,改善患者术后生活质量和预后。
Objective:To explore the clinical effects of transurethral resection of prostate(TURP)with preservation of prostatic apex urethral mucosa for benign prostatic hyperplasia(BPH).Methods:The clinical data of 92 patients with BPH were retrospectively analyzed. The patients with routine TURP were included in control group(n=40),and the patients with TURP of preservation of prostatic apex urethral mucosa were included in observation group(n=52). The urodynamic parameters[maximum urinary flow rate(Qmax),mean urinary flow rate(Qave),residual urine volume(RUV)],detrusor function[bladder contraction index(BCI)],symptoms severity[International Prostate Symptom Score(IPSS)]and quality of life[quality of life scale of patient with benign prostatic hyperplasia(BPHQLS)]were compared between the two groups before and at 6 th month after operation. The levels of urinary cytokines[tumor necrosis factor-α(TNF-α),transforming growth factor-β1(TGF-β1)]were observed in the two groups before and at 3 rd and 7 th day after operation. And the perioperative basic indicators and occurrence of complications within 6 months after operation were analyzed in the two groups.Results:At 6 th month after operation,the levels of Qmaxand Qavewere significantly higher than the preoperative levels while the RUV level was significantly lower than the preoperative level(P<0.05),but there were no statistically significant differences in the levels between the two groups(P>0.05). The BCI level in observation group was not significantly different from that before operation(P>0.05),but significantly higher than that in control group at the same time period(P<0.05). The IPSS scores before operation in the two groups were significantly lower than the preoperative levels,and the score in observation group was significantly lower than that in control group at the same time period(P<0.05). The BPHQLS scores before operation in the two groups were significantly higher than the preoperative levels,and the score in observation group was significantly higher than that in control group(P<0.05). At 3 rd and 7 th day after operation,the urinary TNF-α levels in the two groups were significantly lower than the preoperative levels,and the level in observation group was significantly lower than that in control group at the same time point(P<0.05),and the urinary TGF-β1 levels in the two groups were significantly higher than the preoperative levels,and the level in observation group was significantly higher than that in control group(P<0.05). There were no significant differences in the quality of gland resection and operative time between-groups(P>0.05),but the intraoperative blood loss,bladder irrigation time,catheter indwelling time and postoperative discharge time were significantly less than those in control group(P<0.05). There were no significant differences in the incidence of repeated hematuria,urinary tract infection,bladder injury and retrograde ejaculation between the two groups within 6 months after operation(P>0.05),and the incidence of stress urinary incontinence and urge incontinence in observation group was significantly lower than tha in control group(P<0.05).Conclusions:TURP with preservation of prostatic apex urethral mucosa has equivalent effects for BPH with conventional surgical treatment,but the former one can improve the postoperative recovery efficiency by reducing the incidence of urinary incontinence,and it is helpful to optimize the prognosis and quality of life.
Objective:To explore the clinical effects of transurethral resection of prostate(TURP)with preservation of prostatic apex urethral mucosa for benign prostatic hyperplasia(BPH).Methods:The clinical data of 92 patients with BPH were retrospectively analyzed. The patients with routine TURP were included in control group(n=40),and the patients with TURP of preservation of prostatic apex urethral mucosa were included in observation group(n=52). The urodynamic parameters[maximum urinary flow rate(Qmax),mean urinary flow rate(Qave),residual urine volume(RUV)],detrusor function[bladder contraction index(BCI)],symptoms severity[International Prostate Symptom Score(IPSS)]and quality of life[quality of life scale of patient with benign prostatic hyperplasia(BPHQLS)]were compared between the two groups before and at 6 th month after operation. The levels of urinary cytokines[tumor necrosis factor-α(TNF-α),transforming growth factor-β1(TGF-β1)]were observed in the two groups before and at 3 rd and 7 th day after operation. And the perioperative basic indicators and occurrence of complications within 6 months after operation were analyzed in the two groups.Results:At 6 th month after operation,the levels of Qmaxand Qavewere significantly higher than the preoperative levels while the RUV level was significantly lower than the preoperative level(P<0.05),but there were no statistically significant differences in the levels between the two groups(P>0.05). The BCI level in observation group was not significantly different from that before operation(P>0.05),but significantly higher than that in control group at the same time period(P<0.05). The IPSS scores before operation in the two groups were significantly lower than the preoperative levels,and the score in observation group was significantly lower than that in control group at the same time period(P<0.05). The BPHQLS scores before operation in the two groups were significantly higher than the preoperative levels,and the score in observation group was significantly higher than that in control group(P<0.05). At 3 rd and 7 th day after operation,the urinary TNF-α levels in the two groups were significantly lower than the preoperative levels,and the level in observation group was significantly lower than that in control group at the same time point(P<0.05),and the urinary TGF-β1 levels in the two groups were significantly higher than the preoperative levels,and the level in observation group was significantly higher than that in control group(P<0.05). There were no significant differences in the quality of gland resection and operative time between-groups(P>0.05),but the intraoperative blood loss,bladder irrigation time,catheter indwelling time and postoperative discharge time were significantly less than those in control group(P<0.05). There were no significant differences in the incidence of repeated hematuria,urinary tract infection,bladder injury and retrograde ejaculation between the two groups within 6 months after operation(P>0.05),and the incidence of stress urinary incontinence and urge incontinence in observation group was significantly lower than tha in control group(P<0.05).Conclusions:TURP with preservation of prostatic apex urethral mucosa has equivalent effects for BPH with conventional surgical treatment,but the former one can improve the postoperative recovery efficiency by reducing the incidence of urinary incontinence,and it is helpful to optimize the prognosis and quality of life.
引文
[1]马丁,尚吉文,王靖宇,等.良性前列腺增生临床进展危险因素与分子标志物的相关性研究.中华泌尿外科杂志,2018,39(3):226-227.
[2]卢一平,梁嘉宇.良性前列腺增生微创治疗新进展.中华男科学杂志,2016,22(5):387-392.
[3]章雪峰,钟小平,章冠军,等.老年良性前列腺增生患者经尿道汽化电切治疗效果的影响因素.中国老年学杂志,2013,33(21):5276-5278.
[4]杨波,王颖.双极等离子电切术对老年高危前列腺增生患者的疗效及生活质量的影响.中国老年学杂志,2016,36(9):2239-2240.
[5]庞程,邱敏捷,杨志坚,等.钬激光与等离子技术对治疗良性前列腺增生的疗效比较.中国内镜杂志,2015,21(5):521-524.
[6]SONKSEN J,BARBER NJ,SPEAKMAN MJ,et al.Prospective,randomized,multinational study of prostatic urethral lift versus transurethral resection of the prostate:12-month results from the BPH6 study.Eur Urol,2015,68(4):643-652.
[7]中国研究型医院学会泌尿外科学专业委员会.中国良性前列腺增生症经尿道等离子双极电切术治疗指南(2018标准版).中华医学杂志,2018,98(20):1549-1560.
[8]WONG CK,CHOI EP,CHAN SW,et al.Use of the international prostate symptom score(IPSS)in Chinese male patients with benign prostatic hyperplasia.Aging Male,2017,20(4):241-249.
[9]郭燕芳,史静琤,胡明,等.良性前列腺增生症患者生活质量量表的修订与考评.中国卫生统计,2008,25(3):260-263.
[10]施安,孙杰,童臻,等.经尿道前列腺钬激光剜除术后压力性尿失禁危险因素分析.临床泌尿外科杂志,2018,33(4):269-272.
[11]沈海祥,谢立平.良性前列腺增生的微创治疗新技术.临床泌尿外科杂志,2018,33(4):290-294.
[12]余闫宏,姜安超,齐书武,等.前列腺剜除术导致尿失禁的力学因素浅析(附2270例报道).中国男科学杂志,2016,30(1):34-37.
[13]刘尚文,王亚东,林峰.经尿道前列腺剜除术中保留12点处尿道黏膜对术后控尿的影响.微创泌尿外科杂志,2018,7(1):41-44.
[14]王颖.盆底肌锻炼对前列腺切除术后暂时性尿失禁的影响.中国临床医学,2014,21(4):482-483.
[15]李实,于广海.腹腔镜前列腺癌根治术治疗经尿道前列腺电切术发现的前列腺癌14例临床分析.中华男科学杂志,2017,23(10):903-907.
[16]WANG XJ,ZHUO J,LUO GH,et al.Androgen deprivation accelerates the prostatic urethra wound healing after Thulium laser resection of the prostate by promoting re-epithelialization and regulating the macrophage polarization.Prostate,2017,77(7):708-717.
[17]朱文座,李刚,李奎.经尿道前列腺电切术中切除的组织大小对术后近期疗效的分析.中华男科学杂志,2016,22(9):813-816.
[18]王旭刚,莫乃新,袁晓亮,等.保留部分尿道粘膜钬激光前列腺剜除术的临床观察和手术技巧探讨.中华男科学杂志,2017,23(10):954-956.
[2]卢一平,梁嘉宇.良性前列腺增生微创治疗新进展.中华男科学杂志,2016,22(5):387-392.
[3]章雪峰,钟小平,章冠军,等.老年良性前列腺增生患者经尿道汽化电切治疗效果的影响因素.中国老年学杂志,2013,33(21):5276-5278.
[4]杨波,王颖.双极等离子电切术对老年高危前列腺增生患者的疗效及生活质量的影响.中国老年学杂志,2016,36(9):2239-2240.
[5]庞程,邱敏捷,杨志坚,等.钬激光与等离子技术对治疗良性前列腺增生的疗效比较.中国内镜杂志,2015,21(5):521-524.
[6]SONKSEN J,BARBER NJ,SPEAKMAN MJ,et al.Prospective,randomized,multinational study of prostatic urethral lift versus transurethral resection of the prostate:12-month results from the BPH6 study.Eur Urol,2015,68(4):643-652.
[7]中国研究型医院学会泌尿外科学专业委员会.中国良性前列腺增生症经尿道等离子双极电切术治疗指南(2018标准版).中华医学杂志,2018,98(20):1549-1560.
[8]WONG CK,CHOI EP,CHAN SW,et al.Use of the international prostate symptom score(IPSS)in Chinese male patients with benign prostatic hyperplasia.Aging Male,2017,20(4):241-249.
[9]郭燕芳,史静琤,胡明,等.良性前列腺增生症患者生活质量量表的修订与考评.中国卫生统计,2008,25(3):260-263.
[10]施安,孙杰,童臻,等.经尿道前列腺钬激光剜除术后压力性尿失禁危险因素分析.临床泌尿外科杂志,2018,33(4):269-272.
[11]沈海祥,谢立平.良性前列腺增生的微创治疗新技术.临床泌尿外科杂志,2018,33(4):290-294.
[12]余闫宏,姜安超,齐书武,等.前列腺剜除术导致尿失禁的力学因素浅析(附2270例报道).中国男科学杂志,2016,30(1):34-37.
[13]刘尚文,王亚东,林峰.经尿道前列腺剜除术中保留12点处尿道黏膜对术后控尿的影响.微创泌尿外科杂志,2018,7(1):41-44.
[14]王颖.盆底肌锻炼对前列腺切除术后暂时性尿失禁的影响.中国临床医学,2014,21(4):482-483.
[15]李实,于广海.腹腔镜前列腺癌根治术治疗经尿道前列腺电切术发现的前列腺癌14例临床分析.中华男科学杂志,2017,23(10):903-907.
[16]WANG XJ,ZHUO J,LUO GH,et al.Androgen deprivation accelerates the prostatic urethra wound healing after Thulium laser resection of the prostate by promoting re-epithelialization and regulating the macrophage polarization.Prostate,2017,77(7):708-717.
[17]朱文座,李刚,李奎.经尿道前列腺电切术中切除的组织大小对术后近期疗效的分析.中华男科学杂志,2016,22(9):813-816.
[18]王旭刚,莫乃新,袁晓亮,等.保留部分尿道粘膜钬激光前列腺剜除术的临床观察和手术技巧探讨.中华男科学杂志,2017,23(10):954-956.