经直肠高强度聚焦超声治疗高危良性前列腺增生的尿动力学评价

Evaluate the effectiveness of the treatment of high risk benign prostatic hyperplasia with transrectal high-intensity focused ultrasound by urodynamic test

目的利用尿动力学检查评价经直肠高强度聚焦超声（TR—HIFU）治疗高危良性前列腺增生（BPH）的疗效。方法130例高危BPH患者中，多伴有糖尿病、心脑血管及肺部疾病等。采用美国Focus Surgery公司生产的Sonablate-500型高强度聚焦超声（HIFU）治疗仪进行经直肠（TR）-HIFU治疗。治疗前、治疗后1、3个月通过国际前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Qmax）、残余尿量（PVR）、压力-流率（A—G）值等评价疗效。结果本组130例高危BPH患者均治疗顺利。TR．HIFU治疗时间15～85min，107例获得3个月的观察随访。术后3个月症状改善最明显，夜尿次数减少，与治疗前比较，IPSS由（27．0±11．5）分降至（8．5±1．4）分，Qmax由（5．7±2．3）ml／s增至（14．1±4．2）ml／s，PVR由（118．5±78．0）ml减至（30．0±15．0）ml，A-G值由62．4±19.3减至25．6±13．0，排尿量由（85．8±42．0）ml增至（194．0±52．0）ml（P值均〈0．05）。结论TR—HIFU治疗高危BPH具有很高的安全性，近期疗效满意，术后各项尿动力学检查参数明显改善。

Objective To evaluate the effectiveness of the treatment of high risk benign prostatic hyperplasia （BPH） with transrectal high-intensity focused ultrasound （TR-HIFU） by urodynamic test. Methods One hundred and thirty patients with BPH, most of who suffering with diabetes mellitus, cardio-cerebrovascular disease, respiratory disease. All patients were given the operation with Sonablate-500 high-intensity focused uhrasound （HIFU）. International prostate symptom score （IPSS）, quality of life （QOL）, maximum urinary flow rate （Qmax）, post void residual urine volume （PVR）, pressure-flow tests （A-G） were employed for the evaluation of curatives effect on preoperation, 30th and 90th day after the treatment. Results The duration of the TR-HIFU prostate ablation treatment was 15-85 min. One hundred and seven patients after treatment were followed up for 3 months. Compared the effect before treatment with that after treatment, IPSS improved from （ 27.0 ± 11.5 ） scores to （ 8.5 ± 1.4 ） scores, Qmax increased from （5.7 ± 2.3） ml/s to （ 14.1 ± 4.2） ml/s, PVR decreased from （ 118.5 ± 78.0） ml to （30.0 ± 15.0） ml,A-G parameters reduced from 62.4 ± 19.3 to 25.6 ± 13.0 and urine volume （VV） increased from （85.8 ± 42.0 ） ml to （194.0 ± 52.0） ml. The parameters all altered obviously （P 〈 0.05）. Conclusions TR-HIFU appears highly attractive as a new optional, safe and efficacious and minimally invasive treatment for the high risk BPH. Main post-operative urodynamic parameters are more obviously improved than those of the preoperation.