老年高危前列腺增生治疗的选择——1065例分析

Options for high-risk benign prostatic hyperplasia in elderly： a retrospective study of 1065 cases

目的提高老年高危前列腺增生（BPH）治疗效果。方法回顾分析了中日友好医院70岁以上的1065例高危BPH患者的治疗的安全性和有效性。平均每例合并心血管等高风险因素有4种以上。采用非手术治疗、膀胱造瘘术、腔内手术及开放手术切除前列腺四类治疗方法，观察效果。结果非手术治疗352例，应用药物及留置尿管，未加重合并症，但携带尿管引起生活不方便并发尿路感染。膀胱造瘘术102例，未加重合并症，但伴有尿路感染100％，生活不便。腔内手术切除前列腺326例，发生严重合并症11例，其中2例死亡。开放手术治疗85例，发生严重合并症14例，其中l例死亡。结论非手术治疗及膀胱造瘘术治疗方法安全，但效果有限，生活不便；手术切除前列腺提高生活质量明显，效果良好，但有加重合并症的风险。

Objective To evaluate the therapeutic effect for high risk benign prostatic hyperplasia （BPH） in the elderly. Methods Clinical data of 1065 high-risk BPH elderly patients with age over 70 years （ranging from 70 to 99 years, mean 80.44 years） who were admitted in our department during March 2002 to February 2012 were collected and retrospectively analyzed. All patients averagely had at least 4 complications, such as diabetes, hypertension, hyperlipidemia, cardiovascular events, and so on. The therapeutic safety and reliability of non-surgical treatment, bladder fistulization, transurethral and suprapubic prostatectomy were evaluated. Results Totally 352 cases received non-surgical treatment, but in whom catheterization induced urinary tract ilafection and life inconvenience though having no effect on the complications. Among the 102 cases undergoing bladder fistulization, no complication was aggravated but urinary tract infection occurred in all patients due to catheterization. In 326 cases treated with transurethral prostatectomy, 11 of them suffered from severe complications, and 2 died. A total of 85 cases were treated with suprapubic prostatectomy. There were 14 cases suffering from severe complications and 1 died. Conclusion Non-surgical and bladder fistulization are safe, but can not improve patients＇ life satisfaction. The prostatectomy is effective, but is susceptible to aggravated complications in high-risk elderly patients.