良性前列腺增生手术适应证探讨与方法的选择

Discussion of Benign Prostatic Hyperplasia Surgery Indication and Selection of Therapies

良性前列腺增生(benign prostatic hyperplasia,BPH)是中老年患者的常见疾病,生活水平提高和寿命延长使得患者数量在逐年增加。电切镜的应用使下尿路疾病尤其是前列腺增生症的治疗发生了根本性的改变,新的治疗方法近年发展较快,并在BPH治疗过程中得到了广泛运用。前列腺增生症患者症状和程度各不相同,并且高龄高危患者居多,其手术适应证需要进一步探讨。开放前列腺切除术、经尿道前列腺电切术、经尿道前列腺汽化电切术、经尿道等离子前列腺电切术是目前常用的治疗方法,经尿道激光治疗、腹腔镜手术近几年开始尝试,初步应用证实其应用得当是有效、微创、并发症少的治疗方法,因此发展迅速。微波、超声消融、支架植入治疗目前较少应用,但有其适应证,尚不能替代经尿道前列腺电切术,可作为对症辅助治疗或适用于无法耐受手术者。结合国内外BPH诊治指南提出的手术适应证,查阅近年国内外发表相关文献,对于指南在实际应用和执行中遇到的问题与解决办法进行探讨。对各种外科手术的临床疗效予以对比和总结,探讨良性前列腺增生症外科治疗的临床决策问题。

Benign prostatic hyperplasia （BPH） is a common disease in senile patients. The amount of BPH patients is increasing rapidly in recent years for raised living standard and life lengthening. Application of resectoscope made the therapy for lower urinary tract disease especially the BPH change greatly. Many kinds of new therapies for BPH have come out in the past few years, which are widely used in urology clinic. BPH patients have various symptoms of different degree and most of them are old age and of poor health, so the indication of surgery should be discussed. Open prostatectomy, transurethral resection of the prostate （TURP）, transurethral vaporization of the prostate （TUVP） and transurethral bipolar vaporization of the prostate （TUBVP） are common therapies, transurethral laser resection of prostate, laparoscopic surgery is in attempt use, and the initial result is that these therapies are proven to be effective, minimal invasive and few complication, so their development is rapid. Microwave therapy,ultrasound ablation and stent implantation are not often used, which could be used as supplementary therapy to relieve symptoms or for those could not endure surgery. Combined with review of the surgery indication for BPH recommended by domestic and international BPH guidelines and the literature published recently, to discuss the resolution of problem in practical using of the guideline. The clinical results of the surgical treatments are compared to approach the surgical treatment decision making for BPH.