介入栓塞与经尿道电切术治疗高龄良性前列腺增生症临床对比
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摘要
目的探讨前列腺动脉介入栓塞术(PAE)治疗高龄良性前列腺增生症(BPH)的安全性及近期疗效,并与经尿道前列腺电切术(TURP)作比较。方法回顾性分析2014年6月至2017年6月收治的143例高龄BPH患者临床资料,其中接受PAE治疗57例(PAE组),接受TURP治疗86例(TURP组)。对比两组手术创伤、术后并发症及近期疗效。结果两组患者在手术创伤、术后并发症方面差异均有显著统计学意义(P<0.01),PAE组术中出血量[(4.76±1.92) mL对(156.56±83.12) mL]、止痛药应用次数[(0.12±0.33)次对(0.76±1.35)次]、术后住院时间[(2.47±1.91) d对(7.21±2.44) d]、ClavienⅡ级及以上并发症(χ~2=5.563)均低于TURP组。两组患者近期疗效差异有显著统计学意义(P<0.01),TURP组在前列腺体积[(42.93±11.62) cm~3对(69.82±13.52) cm~3]、国际前列腺症状评分(IPSS)(9.77±1.71对11.82±3.31)、生活质量(QOL)评分(1.87±0.76对2.57±0.59)、最大尿流率(Qmax)[(18.26±3.98) mL/s对(13.90±3.95) mL/s]、残余尿量(PVR)[(36.16±10.67) mL对(45.82±9.43) mL]指标上改善均比PAE组更明显。结论 PAE术治疗高龄BPH患者安全、有效,可作为TURP术补充治疗。
Objective To evaluate the safety and short-term efficacy of prostatic artery embolization(PAE) in treating benign prostatic hyperplasia(BPH) in elderly patients, and to compare its curative effect with that of transurethral resection of prostate(TURP). Methods The clinical data of 143 elderly patients with BPH, who were admitted to authors' hospital during the period from June 2014 to June 2017 to receive treatment, were retrospectively analyzed. Among the 143 elderly patients, PAE was employed in 57(PAE group) and TURP was adopted in 86(TURP group). The surgical injury, postoperative complications and short-term effect were recorded, and the results were compared between the two groups. Results Statistically significant differences in surgical injury and postoperative complications existed between the two groups(P<0.01). Comparing PAE group with TURP group, the amount of intraoperative blood loss was(4.76±1.92)mL vs(156.56 ±83.12) mL, the number of using painkillers was(0.12 ±0.33) vs(0.76 ±1.35) and the postoperative hospitalization duration was(2.47±1.91) vs(7.21±2.44) days. The incidences of the complications of Clavien grade Ⅱ and above in the PAE group were lower than those in the TURP group(χ~2=5.563). The difference in short-term effect between the two groups was statistically significant(P<0.01). Comparing TURP group with PAE group after the treatment, the prostate volume was(42.93±11.62) cm~3 vs(69.82±13.52)cm~3, the international prostate symptom score(IPSS) was(9.77±1.71) vs(11.82±3.31), the quality of life(QOL) score was(1.87±0.76) vs(2.57±0.59), the maximum urine flow(Qmax) was(18.26±3.98) mL/s vs(13.90±3.95) mL/s, and the residual urine volume(RUV) was(36.16±10.67) mL vs(45.82±9.43) mL; in the TURP group the improvement of all the above indexes was more obvious than that in the PAE group.Conclusion For the treatment of BPH in elderly patients, PAE is safe and effective, and PAE can be used as supplementary therapy for TURP procedure.
Objective To evaluate the safety and short-term efficacy of prostatic artery embolization(PAE) in treating benign prostatic hyperplasia(BPH) in elderly patients, and to compare its curative effect with that of transurethral resection of prostate(TURP). Methods The clinical data of 143 elderly patients with BPH, who were admitted to authors' hospital during the period from June 2014 to June 2017 to receive treatment, were retrospectively analyzed. Among the 143 elderly patients, PAE was employed in 57(PAE group) and TURP was adopted in 86(TURP group). The surgical injury, postoperative complications and short-term effect were recorded, and the results were compared between the two groups. Results Statistically significant differences in surgical injury and postoperative complications existed between the two groups(P<0.01). Comparing PAE group with TURP group, the amount of intraoperative blood loss was(4.76±1.92)mL vs(156.56 ±83.12) mL, the number of using painkillers was(0.12 ±0.33) vs(0.76 ±1.35) and the postoperative hospitalization duration was(2.47±1.91) vs(7.21±2.44) days. The incidences of the complications of Clavien grade Ⅱ and above in the PAE group were lower than those in the TURP group(χ~2=5.563). The difference in short-term effect between the two groups was statistically significant(P<0.01). Comparing TURP group with PAE group after the treatment, the prostate volume was(42.93±11.62) cm~3 vs(69.82±13.52)cm~3, the international prostate symptom score(IPSS) was(9.77±1.71) vs(11.82±3.31), the quality of life(QOL) score was(1.87±0.76) vs(2.57±0.59), the maximum urine flow(Qmax) was(18.26±3.98) mL/s vs(13.90±3.95) mL/s, and the residual urine volume(RUV) was(36.16±10.67) mL vs(45.82±9.43) mL; in the TURP group the improvement of all the above indexes was more obvious than that in the PAE group.Conclusion For the treatment of BPH in elderly patients, PAE is safe and effective, and PAE can be used as supplementary therapy for TURP procedure.
引文
[1]王庭俊,陈纯娴,王中心.老年人良性前列腺增生诊断治疗情况分析[J].中华老年医学杂志,2012,31:943-946.
[2]Sohn JH,Choi YS,Kim SJ,et al.Effectiveness and safety of photoselective vaporization of the prostate with the 120 W HPSGreenlight laser in begin prostatic hyperplasia patients taking oral anticoagulants[J].Korean J Urol,2011,52:178-183.
[3]王建业,宋希双,杜传军,等.良性前列腺增生诊断治疗指南[M].北京:人民卫生出版社,2013:259-261.
[4]Martins Pisco J,Pereira J,Rio Tinto H,et al.How to perform prostatic arterial embolization[J].Tech Vasc Interv Radiol,2012,15:286-289.
[5]李新,金锡御,宋波,等.排尿功能障碍致上尿路损害216例临床分析[J].第三军医大学学报,2010,32:611-613.
[6]Sandhu JS,Jaffe WI,Chung DE,et al.Decreasing electrosurgical transurethral resection of the prostate surgical volume during graduate medical education training is associated with increased surgical adverse events[J].J Urol,2010,183:1515-1519.
[7]Baazeem A,Elhilali MM.Surgical management of begin prostatic hyperplasia:current evdience[J].Nat Clin Pract Urol,2008,5:540-549.
[8]张国栋,段峰,袁凯,等.前列腺动脉栓塞术治疗良性前列腺增生的前景与挑战[J].介入放射学杂志,2014,23:735-738.
[9]陈楚红,龚旻,陈长青,等.经尿道双级等离子汽化电切术治疗高危重前列腺增生[J].中华腔镜泌尿外科杂志·电子版,2012,6:121-124.
[10]Pisco JM,Bilhim T,Pinheiro LC,et al.Medium-and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia:results in 630 patients[J].J Vasc Interv Radiol,2016,27:1115-1122.
[11]谢宜兴,卢川,程永德.经导管前列腺动脉栓塞术治疗前列腺增生[J].介入放射学杂志,2014,23:185-190.
[12]谢庆祥,裴发光,孟象榕,等.前列腺增生组织中血管形成的研究[J].中华泌尿外科杂志,1999,20:246-248.
[13]Camara-Lopes G,Mattedi R,Antunes AA,et al.The histology of prostate tissue following prostatic hyperplasia[J].Int Braz JUrol,2013,39:222-227.
[14]Carnevale FC,Antunes AA.Prostatic artery embolization for enlarged prostates due to benign prostatic hyperplasia.How I do it[J].Cardiovasc Intervent Radiol,2013,36:1452-1463.
[2]Sohn JH,Choi YS,Kim SJ,et al.Effectiveness and safety of photoselective vaporization of the prostate with the 120 W HPSGreenlight laser in begin prostatic hyperplasia patients taking oral anticoagulants[J].Korean J Urol,2011,52:178-183.
[3]王建业,宋希双,杜传军,等.良性前列腺增生诊断治疗指南[M].北京:人民卫生出版社,2013:259-261.
[4]Martins Pisco J,Pereira J,Rio Tinto H,et al.How to perform prostatic arterial embolization[J].Tech Vasc Interv Radiol,2012,15:286-289.
[5]李新,金锡御,宋波,等.排尿功能障碍致上尿路损害216例临床分析[J].第三军医大学学报,2010,32:611-613.
[6]Sandhu JS,Jaffe WI,Chung DE,et al.Decreasing electrosurgical transurethral resection of the prostate surgical volume during graduate medical education training is associated with increased surgical adverse events[J].J Urol,2010,183:1515-1519.
[7]Baazeem A,Elhilali MM.Surgical management of begin prostatic hyperplasia:current evdience[J].Nat Clin Pract Urol,2008,5:540-549.
[8]张国栋,段峰,袁凯,等.前列腺动脉栓塞术治疗良性前列腺增生的前景与挑战[J].介入放射学杂志,2014,23:735-738.
[9]陈楚红,龚旻,陈长青,等.经尿道双级等离子汽化电切术治疗高危重前列腺增生[J].中华腔镜泌尿外科杂志·电子版,2012,6:121-124.
[10]Pisco JM,Bilhim T,Pinheiro LC,et al.Medium-and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia:results in 630 patients[J].J Vasc Interv Radiol,2016,27:1115-1122.
[11]谢宜兴,卢川,程永德.经导管前列腺动脉栓塞术治疗前列腺增生[J].介入放射学杂志,2014,23:185-190.
[12]谢庆祥,裴发光,孟象榕,等.前列腺增生组织中血管形成的研究[J].中华泌尿外科杂志,1999,20:246-248.
[13]Camara-Lopes G,Mattedi R,Antunes AA,et al.The histology of prostate tissue following prostatic hyperplasia[J].Int Braz JUrol,2013,39:222-227.
[14]Carnevale FC,Antunes AA.Prostatic artery embolization for enlarged prostates due to benign prostatic hyperplasia.How I do it[J].Cardiovasc Intervent Radiol,2013,36:1452-1463.