三种镍钛合金支架治疗高危前列腺梗阻患者的疗效观察(附116例报告)

Evaluation of treatment effects of three different urethral stents in patients with prostatic obstruction (Report of 116 cases)

目的 :了解三种镍钛合金支架治疗膀胱颈梗阻的疗效和有效时间。方法 :1992年 3月～ 1999年 6月应用镍钛螺旋支架治疗前列腺梗阻 35例 (螺旋支架组 ) ,应用国产镍钛网状支架治疗前列腺梗阻 5 8例 (国产网架组 ) ,应用 Angiom ed网状支架治疗前列腺增生 2 3例 (Angiomed网架组 )。结果 :螺旋支架组随访 2 1～ 6 0个月 ,显效 8例 (2 2 .8% ) ,有效 2 4例 (6 8.6 % ) ,平均有效时间 10 .8个月 ;国产网架组随访 2 4～ 6 6个月 ,2年有效率 85 .7% ,3年有效率 76 .8% ,4年有效率 6 2 .8% ;Angiom ed网架组随访 2 3～ 6 4个月 ,2年有效率 10 0 % ,3年有效率 91.6 % ,4年有效率 88.8% ,平均有效时间 41.4个月。结论 :螺旋支架仅作为临时支架目前临床已很少应用 ;国产网架有足够大直径和支撑力 ,易嵌入尿道而被粘膜覆盖成为永久性支架 ,而且价格为大多数患者所接受 ;Angiomed网架有较高组织相容性 ,刺激性小 ,易为上皮覆盖 ,其疗效优于国产网架。

Purpose: In order to know the effectiveness of three different urethral stents in the treatment of prostatic obstruction . Methods: 35 cases were treated with spiral stents (group on e) from Mar.1992 to Jun.1999,including benign prostatic hyperplasia (BPH) 34 cases, prostatic cancer 1 case, mean age 71.5 years. From Oct.1993 to Jun.1999,58 cases were implanted with tubular meshes (group two), including BPH 54, advanced prostate cancer 4, mean age 76.9 years. During the same period as group tow, 23 cases with BPH were treated with Angiomed mesh (Urolume memotherm,group three), mean age was 75.1years, in which 17 received epidural anesthesia and percutanous cystostomy. Results: For group one, good results were achieved in eight cases ( 22.8 %) and significant improvements occurred in 24 ( 68.5 %) with a follow up of 21～60 months, mean effective time was 10.8 months. For group two, a dramatically effective rate was obtained in 54 (96%), with a follow up of 24～66 months (mean 42.6 months), two, three and four year effective rates were 85.7 %, 78% and 63%. With a follow up of 23～64 months, we have got 100%, 91.6% and 88.8 % of two, three and four year effective rates in group three. Conclusions: Spiral stent has poor effective rate and is rarely used an present. The tubular mesh with a diameter large enough and good antipressure properties makes it possible to be inserted into the urethral and covered by urothelium. As a permanent stent, a 78% and 63% effective rate was achieved at least three and four years after the implantation and many patients can afford the expenses. Compared with the tubular mesh, Angiomed stent wit h high compatibility with the tissue, low irritation and easy coverage by urothelium, has shown a 90% three year effective rate. The tubular mesh should be further improved in quality.