经直肠高强度聚焦超声(HIFU)治疗良性前列腺增生的临床研究

High-intensity focused ultrasound for treating patients with benign prostatic hyperplasia

目的探讨经直肠高强度聚焦超声(high-intensity focused ultrasound,HIFU)治疗良性前列腺增生(BPH)的有效性和安全性。方法对150例BPH患者采用Sonablate 500型“经直肠超声聚能刀”进行前列腺消融术。在术前、术后30min,1、2、6和12个月,经直肠超声观察前列腺和前列腺部尿道的影像学变化,通过尿液分析、国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)和残余尿量(PVR)进行疗效评估,同时观察术后并发症。23例术后12个月行排尿期膀胱尿道造影。结果对143例进行了12个月的观察随访,术后IPSS评分和QOL评分降低,PVR减少,Qmax明显提高(P<0.01),前列腺体积缩小(P<0.05)。前列腺消融时间25～90min。术后留置尿管时间为3～19d,7例术后反复排尿困难、药物治疗效果不佳者行TURP手术,3例患者出现附睾炎,1例术后15d发生尿道直肠瘘。术后经直肠超声观察和膀胱尿道造影,证实术后前列腺部尿道较术前明显增宽。结论“经直肠超声聚能刀”前列腺消融术,能对前列腺组织进行选择性破坏,具有微创(无血手术)、安全和并发症少等优点。对前列腺中叶增生明显者可联合TURP治疗。“经直肠超声聚能刀”治疗BPH近期疗效满意,远期疗效有待进一步观察。

Objective To evaluate the safety and effectiveness of high-intensity focused ultrasound （HIFU） for treating with benign prostatic hyperplasia （BPH）. Methods The study included 150 patients with BPH. For this study, the third-generation devices called the Sonablate -500^TM was used. Serial study was performed at 30minutes, 1 month, 2 months, 6 months and 12 months after therapy. The urinalysis was observed and postoperatively. International prostate symptom score （IPSS）, quality of life index （QOL）, maximum urinary flow rate （Qmax）, post void residual urine volume （PVR） and the change of the prostatic volume through transrectal B ultrasounds were employed for the evaluation of effect after the treatment. Meanwhile postoperative complications were observed. The cystourethrography was done in 23 patients within 1 year postoperatively. Results 143 patients after treatment were followed up for 12 months, the mean IPSS symptom score was improved. QQL index became lower, while Qmax improved, PVR decreased （P〈0.01） and volume of prostate reduced （P〈0.05） significantly. The duration of the HIFU prostate ablation treatment was 25-90mins.The general time with indwelling catheter after treatment was 3-19 days. Seven patients underwent transurethral resection of prostste （TURP） after HIFU treatment for the recurrent urinary retention which could not be treated by medicine. One patient had urethrorectal fistula occurred 15 days after HIFU treatment. The transrectal B ultrasounds and the cystourethrography revealed apparently that the volume of prostate is condensed while the prostatic urethra was obviously wider after the ablation. Conclusion The advantages of HIFU prostate ablation include safety, efficacious, less invasiveness and minimal complications for the treatment of BPH. TURP can be combined with HIFU treatment in BPH with large middle lobes obviously. As a new form of treatment, there is uncertainty as to its long-term effects. The data on longer follow up are keenly awaited.