改良尿道腔内剜除术联合膀胱造瘘治疗高龄前列腺增生的临床研究

尹文利; 王娟; 李永禄; 李双辉; 高峰; 李双标

doi:10.7619/jcmp.20211909

改良尿道腔内剜除术联合膀胱造瘘治疗高龄前列腺增生的临床研究

1.
河北省沧州中西医结合医院泌尿外科, 河北沧州, 061000
2.
河北省沧州市人民医院门急诊科, 河北沧州, 061000

基金项目:

河北省卫生和计划生育委员会科研基金项目 20180974

详细信息

中图分类号: R256.53;R697.32
计量
- 文章访问数: 330
- HTML全文浏览量: 193
- PDF下载量: 7
出版历程
- 收稿日期: 2021-05-07
- 网络出版日期: 2021-08-22
- 发布日期: 2021-08-27

Clinical study of modified urethral enucleation combined with cystostomy in the treatment of elderly prostatic hyperplasia patients

1.
Department of Urological Surgery, Cangzhou Hospital of Integrated Traditional Chineseand Western Medicine in Hebei Province, Cangzhou, Hebei, 061000
2.
Outpatient and EmergencyDepartment, Cangzhou People′s Hospital in Hebei Province, Cangzhou, Hebei, 061000

摘要

摘要:
目的观察改良尿道腔内剜除术(M-PKEP)联合膀胱造瘘治疗高龄前列腺增生(BPH)的效果。
方法选取诊断为BPH并进行治疗的119例患者为研究对象，按照随机分组原则将其分为观察组(n=60, M-PKEP术联合膀胱造瘘)和对照组(n=59, M-PKEP术)。比较2组治疗效果、生活质量、国际前列腺症状评分(IPSS)以及并发症的发生情况，分析术后储尿症状改善的影响因素。
结果治疗后, 2组最大尿流率(Q_max)升高，残余尿量(RUV)、下尿路储尿期症状评分(IPSS-S)均下降，且观察组改善程度优于对照组，差异有统计学意义(P < 0.05); 2组并发症发生率比较，差异无统计学意义(P>0.05); 年龄(≥80岁)、逼尿肌收缩力(≥40 cmH₂O)、残余尿量(≥100 mL)、夜尿次数(≥2次)均是影响患者IPSS-S的独立危险因素。
结论高龄BPH患者采用M-PKEP术联合膀胱造瘘治疗具有较好的疗效，术后建议及时对逼尿肌收缩力、RUV和夜尿频次进行干预以提升患者生活质量。
- 前列腺增生 /
- 改良尿道腔内剜除术 /
- 膀胱造瘘 /
- 夜尿频次 /
- 生活质量
Abstract:
Objective To observe the clinical effect of modified urethral enucleation (M-PKEP) combined with cystostomy in the treatment of elderly prostatic hyperplasia (BPH) patients.
Methods A total of 119 patients diagnosed as BPH and given treatment were selected as study subjects, and were randomly divided into observation group (n=60, M-PKEP combined with cystostomy) and the control group (n=59, M-PKEP). The treatment effects, quality of life, international prostate symptom score (IPSS) and occurrence of complications between the two groups were compared, and influencing factors for improvement of symptoms in postoperative urine storage period were analyzed.
Results After treatment, the maximum urinary flow rate (Q_max) was significantly increased, and the residual urine volume (RUV) and IPSS storage score(IPSS-S) were significantly decreased in the two groups, and the improvement degree was more obvious in the observation group (P < 0.05). There was no difference in incidence of complications between the two groups (P>0.05). Age (≥80 years), detrusor contractibility (≥40 cmH₂O), residual urine volume (≥100 mL), nocturia frequency (≥2 times) were all independent risk factors affecting the IPSS-S of patients.
Conclusion M-PKEP combined with cystostomy in the treatment of elderly BPH patients has a good curative effect. It is suggested that timely intervention on detrusor contractility, RUV and nocturia frequency after surgery can improve theirquality of life.
- prostatic hyperplasia /
- modified urethral enucleation /
- cystostomy /
- nocturia frequency /
- quality of life

HTML全文

表 1 2组基线资料比较(x±s)

组别	年龄/岁	病程/年	前列腺质量/g	增生程度			最大尿流量/(mL/s)
组别	年龄/岁	病程/年	前列腺质量/g	1度	2度	3度	最大尿流量/(mL/s)
观察组(n=60)	81.58±5.03	5.23±1.49	57.45±10.11	20	21	19	6.30±1.44
对照组(n=59)	82.03±4.68	5.08±1.39	57.83±10.61	23	23	13	6.36±1.65

下载: 导出CSV

表 2 2组治疗效果比较(x±s)

组别	Q_max/(mL/s)		RUV/mL
组别	治疗前	治疗后	治疗前	治疗后
观察组(n=60)	8.42±0.31	22.59±1.64^*#	158.85±1.57	13.94±1.39^*#
对照组(n=59)	8.46±0.25	18.27±1.01^*	158.82±1.56	15.96±1.41^*
Q_max: 最大尿流率; RUV: 残余尿量。与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。

下载: 导出CSV

表 3 2组IPSS、QOL评分比较(x±s) 分

组别	IPSS		QOL评分
组别	治疗前	治疗后	治疗前	治疗后
观察组(n=60)	23.70±1.51	4.33±1.33^*#	5.37±1.57	0.91±0.77^*#
对照组(n=59)	23.60±1.96	6.65±1.45^*	5.21±1.33	1.41±0.36^*
IPSS: 国际前列腺症状评分; QOL: 生活质量。与治疗前比较, *P < 0.05; 与对照组比较, #P < 0.05。

下载: 导出CSV

表 4 2组并发症比较[n(%)]

组别	尿路感染	排尿困难	低钠血症
观察组(n=60)	2(3.33)	4(6.67)	3(5.00)
对照组(n=59)	3(5.08)	7(11.86)	5(8.47)

下载: 导出CSV

表 5 IPSS-S的单因素分析(x±s)

指标		IPSS-S/分	t	P
年龄	≥80岁(n=31)	9.74±1.37	11.048	< 0.01
	< 80岁(n=88)	6.21±1.95
逼尿肌收缩力	≥40 cmH₂O(n=34)	10.33±1.33	17.563	< 0.01
	< 40 cmH₂O(n=85)	5.65±1.45
残余尿量	≥100 mL(n=31)	9.21±1.77	8.537	< 0.01
	< 100 mL(n=88)	6.10±1.77
夜尿频次	≥2次(n=43)	9.76±1.17	11.930	< 0.01
	< 2次(n=76)	6.55±1.77
IPSS-S: 下尿路储尿期症状评分。

下载: 导出CSV

表 6 IPSS-S的多因素分析

因素	β	S. E.	Wald	P	OR	95%CI
年龄(≥80岁)	1.02	2.36	1.32	< 0.01	1.92	1.90~1.93
逼尿肌收缩力(≥40 cmH₂O)	1.06	3.27	1.33	< 0.01	1.63	1.33~2.32
残余尿量(≥100 mL)	0.37	4.14	1.69	< 0.01	1.79	1.63~2.07
夜尿频次(≥2次)	0.19	3.64	1.85	< 0.01	1.36	1.03~14.32

下载: 导出CSV

参考文献(15)

[1]	王春晖, 平秦榕, 王英宝, 等. PKRP和PKEP治疗良性前列腺增生的对照研究[J]. 重庆医学, 2018, 47(32): 4160-4163. doi: 10.3969/j.issn.1671-8348.2018.32.020
[2]	林阳彦, 邱春明, 杨勇, 等. 保留前叶经尿道前列腺剜除术治疗前列腺增生的5年疗效分析[J]. 实用医学杂志, 2020, 36(24): 3394-3398. doi: 10.3969/j.issn.1006-5725.2020.24.018
[3]	谢铁军, 任明华, 郭鹏宇. 半导体激光剜除术与等离子剜除术治疗良性前列腺增生有效性和安全性的Meta分析[J]. 哈尔滨医科大学学报, 2020, 54(4): 450-455. https://www.cnki.com.cn/Article/CJFDTOTAL-HYDX202004027.htm
[4]	陈晓君, 陈婧, 叶木石, 等. 三种术式治疗高龄高危前列腺增生症的疗效比较[J]. 实用医学杂志, 2019, 35(23): 3618-3623. doi: 10.3969/j.issn.1006-5725.2019.23.009
[5]	王刚, 姚丽霞, 杨涛, 等. 三种不同腔内技术治疗重度前列腺增生的比较研究[J]. 临床泌尿外科杂志, 2019, 34(6): 478-482. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMW201906017.htm
[6]	肖海涛, 罗明俊. 经尿道双极等离子前列腺剜除术治疗良性前列腺增生伴膀胱结石的效果及其对患者性功能的影响[J]. 现代医学, 2019, 47(5): 502-507. https://www.cnki.com.cn/Article/CJFDTOTAL-TDYX201905003.htm
[7]	蔡大伟, 孔广起. 等离子前列腺剜除联合经膀胱前列腺旋切治疗大体积前列腺增生[J]. 中国微创外科杂志, 2018, 18(5): 419-421. doi: 10.3969/j.issn.1009-6604.2018.05.010
[8]	张少杰, 徐晓峰, 杜泉, 等. 经尿道前列腺等离子双极电切术对良性前列腺增生患者尿动力学及血清前列腺特异抗原、表皮生长因子、前列腺素E₂水平的影响[J]. 实用临床医药杂志, 2019, 23(18): 85-89. doi: 10.7619/jcmp.201918023
[9]	陈厚传, 杨正荣. 经尿道双极等离子前列腺剜除术联合膀胱切开取石治疗高龄大体积良性前列腺增生合并膀胱结石的临床疗效[J]. 国际泌尿系统杂志, 2021, 41(1): 19-23. doi: 10.3760/cma.j.cn431460-20190819-00006
[10]	娄彦亭, 顾燕青, 周业娟, 等. 经尿道前列腺等离子电切和剜除术的疗效及学习曲线分析[J]. 中国男科学杂志, 2018, 32(4): 35-39. doi: 10.3969/j.issn.1008-0848.2018.04.08
[11]	MAHMOUD A M, AHMED O M, ASHOUR M B, et al. In vivo and in vitro antidiabetic effects of Citrus flavonoids; a study on the mechanism of action[J]. Int J Diabetes Dev Countr, 2015, 35(3): 250-263. doi: 10.1007/s13410-014-0268-x
[12]	XU C, ZHANG G, WANG J J, et al. Safety and efficacy of prostatic artery embolization for large benign prostatic hyperplasia in elderly patients[J]. J Int Med Res, 2021, 49(1): 300060520986284. http://www.researchgate.net/publication/348809285_Safety_and_efficacy_of_prostatic_artery_embolization_for_large_benign_prostatic_hyperplasia_in_elderly_patients
[13]	KADIHASANOGLU M, AYDIN M, TASKIRAN M, et al. The Effect of Intravesical Prostatic Protrusion in Patients with Benign Prostatic Hyperplasia: Controlled, Clinical Study[J]. Urol Int, 2019, 103(2): 180-186. doi: 10.1159/000499437
[14]	CALOGERO A E, BURGIO G, CONDORELLI R A, et al. Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction[J]. Aging Male, 2019, 22(1): 12-19. doi: 10.1080/13685538.2018.1434772
[15]	YEH H F, LI T F, TSAI C H, et al. The effects of a Chinese herbal medicine (VGHBPH0) on patients with benign prostatic hyperplasia: a pilot study[J]. J Chin Med Assoc, 2020, 83(10): 967-971. doi: 10.1097/JCMA.0000000000000384