经尿道反馈式微波治疗高危BPH

Effect of transurethral feedback microwave thermotherapy in high risk patients with benign prostate hyperplasia

目的评价经尿道反馈式微波治疗高危BPH患者的疗效及安全性。方法高危BPH患者66例，其中年龄≥80岁者32例，合并高血压31例，糖尿病5例，心功能不全8例，慢性阻塞性肺病10例，脑梗死11例，骨折、截肢或关节僵硬不能截石位3例，凝血功能异常4例，胰腺炎2例，心律失常6例以及恶性肿瘤3例。尿道局部麻醉下采用个体化功率行经尿道反馈式微波治疗。使15％～30％前列腺组织凝固性坏死。对前列腺和周围组织温度实时监测并反馈，确保周围组织的安全。比较治疗前和治疗后3个月B超检查和最大尿流率检查以及国际前列腺症状评分（IPSS）和生活质量评分（QOL）结果。结果66例患者均能耐受治疗，除轻微出血、感染及一过性尿失禁外，无明显外科并发症。前列腺体积由62．2ml减少至44．5ml，IPSS评分由治疗前（23．4±9．5）分降至（11．7±7．9）分，QOI，由（4．5±1．2）分减少至（2．4±1．4）分，最大尿流率由（4．2±3．9）ml／s升高至（11．2±4．4）ml／s，治疗前后差异均有统计学意义（P〈0．05）。结论经尿道反馈式微波治疗高危BPH患者尤其是不能耐受麻醉的患者安全有效。并可用于门诊治疗。

Objective To evaluate the effect of transurethral feedback microwave tbermotherapy with the ProstaLund CoreTherm Device（PLFT） in high risk patients with benign prostate hyperplasia （BPH）. Methods Sixty-six high risk patients diagnosed with BPH, including aged ≥80 in 32 pa tients, hypertension in 31 patients, diabetes in 5 patients, heart failure in 8 patients, chronic obstructive pulmonary disease in 8 patients, cerebral infarction in 11 patients, fracture, amputation or joint stiffness unsuitable for lithotomy position in 3 patients, abnormal blood coagulation in 4 patients, pan creatitis in 2 patients, cardiac arrhythmia in 6 patients and malignant tumor in 3 patients, were treated with PLFT using individual power at urethral local anesthesia, resulting in coagulation necrosis in 15 %--30% of prostate tissue around urethra. Meanwhile, real-time monitoring the temperature of prostate and the tissue around it was used. All patients were evaluated by comparing volume of prostate, maximal urinary flow （Qmax）, international prostate symptom score （IPSS） and quality of life questionnaire （QOL） in pre-treatment and three months after respectively. Results All of patients well tolerated PLFT. There was bleeding lightly, infection lightly and temporary incontinence. There was no severe surgical complication. After three months, the volume of prostate reduced from 62.2 ml to 44.5 ml; IPSS decreased from 23.4 to 11.7; QOL decreased from 4.5 to 2.4; Qmax rised from 4.2 ml/s to 11.2 ml/s. All differences reached significance. Conclusion PLFT is one of effective and safe treatments for patients with BPH especial BPH complicating with severe conditions.