高能聚焦超声治疗良性前列腺增生的临床应用

Clinical application of high-intensity focused ultrasound for benign prostatic hyperplasia

目的探讨Sonablate 500高能聚焦超声治疗仪在良性前列腺增生治疗中的临床应用.方法自2002年12月～2003年12月使用Sonablate 500高能聚焦超声治疗仪对113例良性前列腺增生患者进行经直肠超声消融.结果术后使用国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率以及经直肠B超检测前列腺体积作为评价指标随访12个月.IPSS评分由术前21.6分降至8.8分(P＜0.001).QOL评分由术前4.9降至2.2(P＜0.001).最大尿流率由(5.3±3.5)ml/s增加至(12.3±5.2)ml/s(P＜0.01).前列腺体积由48.9ml降至36.5ml(P＜0.01).术后患者均有轻微的血尿,3例出现附睾炎(占2.7%),35例出现短期血精(占31%),15例出现逆向射精(占13%).结论高能聚焦超声在良性前列腺增生治疗中具有微创、安全、术中无出血、疗效确切、痛苦少、恢复快、并发症少等优点,特别对一些高危的老年患者尤为适合,值得推广应用.

Objective: To discuss the application of transrectal high-intensity focused ultrasound (HIFU) with Sonablate-500 for the treatment of Benign Prostatic Hyperplasia. Methods: From Dec.2002 to Dec.2003, 113 BPH patients had undergone transrectal high-intensity focused ultrasound ablative treatment. Results: After treatment, IPSS, QOL score, peak uroflow rate and prostatic volumn measured by TRUS were used for the evaluation. After an average 12 months follow-up, IPSS decreased from 21.6 to 8.8 (P<0.001); QOL score decreased from 4.9 to 2.2 (P<0.001); peak flow rate increased from (5.3±3.5) ml/s to (12.3±5.2) ml/s; prostatic volume decreased from 48.9 ml to 36.5 ml (P<0.01). Mild hemo urine was noted in all cases after treatment; epididymitis appeared in 3 cases (2.7%); short-term hematospermia appeared in 35 cases (31%); retrograde ejaculation was observed in 15 cases (13%). Conclusions: HIFU with Sonablate-500 for the treatment of Benign Prostatic Hyperplasia is minimally invasive, safe, durability of clinical efficacy, less pain and less complications.