经直肠高能聚焦超声治疗良性前列腺增生:附262例报告

Transrectal high-intensity focused ultrasound for treatment of benign prostatic hyperplasia: report of 262 cases

目的探讨经直肠高能聚焦超声治疗仪在良性前列腺增生治疗中的临床应用。方法 2002年12月2006年12月使用经直肠高能聚焦超声治疗仪对262例良性前列腺增生患者进行高能聚焦超声消融。结果术后使用国际前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Qmax）及经直肠B超检测前列腺体积作为评价指标,随访3年。术后13年IPSS评分、QOL评分、前列腺体积均较术前明显下降,Qmax明显上升,具有显著性差异（P〈0.01）。术后患者均有轻微的血尿,7例出现附睾炎（占2.7%）,66例出现短期血精（占25.2%）,35例出现逆向射精（占13.4%）,1例尿道直肠瘘（占0.3%）,无1例尿失禁。术后3年中有18例（占6.8%）因前列腺体积过大或膀胱颈挛缩改行经尿道前列腺电切术。结论高能聚焦超声在良性前列腺增生治疗中具有微创、安全、术中无出血、疗效确切、痛苦少、恢复快、并发症少等优点,特别对一些高危的老年患者尤为适合,值得推广应用。

Objective To explore the application of transrectal high-intensity focused ultrasound （HIFU） for treatment of benign prostatic hyperplasia （BPH）. Methods From Dec. 2002 to Dec. 2006, 262 BPH patients underwent transrectal HIFU ablative therapy. After the treatment, IPSS, QOL score, peak uroflow rate and prostatic volume measured by TRUS were used for evaluation. Results After 1 to 3 years＇ follow-up, IPSS, QOL score, and prostatic volume all decreased, while the peak uroflow rate increased obviously （P〈0.01）. Mild hematuria was noted in all the cases after the treatment, and epididymitis was found in 7 cases （2.7%）, short-term hematospermia in 66 cases （25.2%）, retrograde ejaculation in 35 cases （13.4%）, and urethro-rectal fistula in 1 case （0.3%）. No urinary incontinence was found in these cases. TURP was performed in 18 cases （6.8% ） in 3 years after the treatment due to an excessively large volume of the prostates or bladder neck contracture. Conclusion HIFU is effective and safe in the treatment of BPH which causes minimal invasion, absence of intraoperative bleeding, good tolerance and few complications, and is especially suitable in elderly patients.