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

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

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。

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.

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