前列腺动脉栓塞术联合经尿道前列腺电切术治疗体积>80 ml良性前列腺增生的短中期随访研究

A short-term and medium-term follow-up study of prostatic arterial embolization combined with transurethral resection of prostate in the treatment of benign prostatic hyperplasia with a prostate volume of 80 ml

目的探讨前列腺动脉栓塞术(PAE)联合经尿道前列腺电切术(TURP)治疗重度(体积>80 ml)良性前列腺增生症(BPH)的临床价值。方法选取郑州市第三人民医院2019年1月至2021年1月收治的92例重度BPH患者为研究对象。按照手术方法分为对照组与观察组,每组46例。对照组实施经TURP,观察组采用PAE联合TURP治疗。对比两组手术指标、并发症发生情况、术前及术后8周尿流动力学指标[最大尿流速(Qmax)、残余尿量(PVR)、最大逼尿肌压力(MDP)]、术前及术后1年前列腺症状[国际前列腺症状量表(IPSS)评分]、生活质量量表(QOL)评分。结果观察组手术时间、膀胱冲洗时间及住院时间均短于对照组,术中出血量低于对照组,腺体切除体积大于对照组(P<0.05)。观察组并发症总发生率(4.35%,2/46)与对照组(15.22%,7/46)比较,差异未见统计学意义(χ^(2)=1.971,P>0.05)。术前,两组Qmax、PVR、MDP比较,差异未见统计学意义(P>0.05);术后8周,两组Qmax、MDP较术前升高,PVR较术前降低,且观察组Qmax、MDP高于对照组,PVR低于对照组(P<0.05)。术前及术后1年,两组IPSS评分、QOL评分比较,差异未见统计学意义(P>0.05);术后1年,两组IPSS评分、QOL评分较术前降低(P<0.05)。结论同TURP相比,采用PAE联合TURP治疗重度BPH能优化手术情况,改善膀胱功能及排尿功能恢复,且两种治疗方式中短期效果确切,安全性较高。

Objective To investigate the clinical value of prostatic arterial embolization(PAE)combined with transurethral resection of prostate(TURP)in the treatment of severe benign prostatic hyperplasia(BPH).Methods Ninty-two patients with severe BPH admitted to the third People’s Hospital of Zhengzhou from January 2019 to January 2021 were selected as the study subjects.According to the operation method,they were divided into control group and observation group,with 46 cases in each group.The control group was treated with TURP,while the observation group was treated with PAE combined with TURP.The preoperative and postoperative urodynamic indexes[maximum urinary flow rate(Qmax),residual urine volume(PVR),maximum detrusor pressure(MDP)],preoperative and postoperative prostate symptoms[International Prostate Symptom Scale(IPSS)scores]and quality of life scale(QOL)scores were compared between the two groups.Results The operation time,bladder washing time and hospitalization time of the observation group were shorter than those of the control group.The blood output during the operation was lower than that of the control group,and the volume of gland resection was larger than that of the control group(P<0.05).The total incidence of complications in the observation group(4.35%,2/46)was not significantly different from that in the control group(15.22%,7/46)(χ^(2)=1.971,P>0.05).Before operation,there was no significant difference in Qmax,PVR and MDP between the two groups(P>0.05).At 8 weeks after operation,the Qmax and MDP of the two groups were higher than those before operation,and the Qmax,MDP levels were higher in the observation group than those in the control group,the level of PVR in the observation group was lower than that in the control group(P<0.05).There was no significant difference in IPSS score and QOL score between the two groups before operation and one year after operation(P>0.05).One year after operation,the IPSS score and QOL score of the two groups were lower than that before operation(P<0.05).Conclusions Compared with TURP,PAE combined with TURP can optimize the operation and improve the recovery of bladder function and urination function in the treatment of severe BPH,and the short-term effect of the two treatment methods is accurate and the safety is high.