良性前列腺增生患者术前尿动力学与经直肠超声检查的意义

Urodynamic Study and Transrectal Ultrasound in Benign Prostatic Hyperplasia Before Operation and Its Significance

【目的】探讨良性前列腺增生(BPH)患者术前行尿动力学检查(UDS)与经直肠超声(TRUS)检查的意义。【方法】2000年9月至2007年6月共诊治BPH患者857例,术前均行UDS与TRUS检查,然后行经尿道前列腺汽化电切术545例,经尿道等离子前列腺电切术302例,耻骨上经膀胱前列腺切除术10例。【结果】TRUS示平均前列腺左右径(5.24±0.85)cm,上下径(3.67±0.57)cm,前后径(3.33±0.45)cm,内外腺厚径比2.37/1,前列腺体积(36.23±18.17)cm3,前列腺质量(57.49±8.26)g。UDS示膀胱容量(320.5±30.0)mL。最大尿流率(Qmax)(5.6±0.8)mL/s。所有病例皆有膀胱出口梗阻(BOO),单纯BOO而不伴明显膀胱功能障碍者407例(47.5%),不稳定膀胱162例(18.9%),低顺应性膀胱136例(15.9%),低顺应性伴不稳定膀胱45例(5.3%),高顺应性膀胱即逼尿肌收缩无力146例(17.0%),逼尿肌括约肌功能失调6例(0.7%)。【结论】对BPH患者,术前常规行TRUS与UDS(如果条件许可术后可进一步行尿动力学追踪),充分评估整个尿路的情况,发现有膀胱功能障碍问题,术前依据发生障碍的原因给予纠正;根据TRUS结果,决定手术方式及估计经尿道切除前列腺组织质量;术后给予辅助治疗。这样才能从根本上达到BPH治疗的目的。

[Objective] To explore the significance of urodynamic study（UDS） and transrectal ultrasound （TRUS） in benign prostatic hyperplasia（BPH） before operation. [Methods] Eight hundred and fifty seven cases of BPH were treated from September 2000 to June 2007. All the patients underwent UDS and TRUS before operation. And transurethral resection of prostate（TURP） was chosen in 545 cases, transurethral bipolar vaporization in 302 cases and suprapublic transvesical prostatectomy in 10 cases. [Results] The average left and right diameter of prostate was （5.24±0.85）cm. The upper and below diameter of prostate was （3.67±0. 57）cm. The anteroposterior diameter was （3.33±0.45）cm. The thickness diameter ratio between inner and external gland was 2.37/1. The volume was （36.23 ±18.17）cm^3. The weight was （57.49±8.26）g. The capacity of bladder was （320.5±30.0）ml. The maximum urine flow rate（Qmax） was （5.6±0.8）ml/s. There was bladder outlet obstruction （BOO） in each case. Unstable bladder was found in 162 cases. Low compliance bladder was in 146 cases. High compliance bladder was in 146 cases. Functional disorder of detrusor and sphincter muscle was in 6 cases. [Conclusion] Patients with BPH should undergo UDS and TRUS before operation to know all the conditions of lower urinary tract. If there are bladder functional disorders, special methods should be taken to correct disorders. Operation method and tissue weight after TURP are obvious. Aid treatment should be given after operation. Thus the aim of BPH treatment can be reached at all.