尿动力学联合经直肠超声检查在良性前列腺增生症患者术前评估中的应用价值

Application of urodynamic examination combined with transrectal ultrasound to preoperative evaluation in benign prostatic hyperplasia

目的探讨尿动力学联合经直肠超声检查在良性前列腺增生症患者术前评估中的应用价值。方法选择150例良性前列腺增生症患者作为研究对象,术前行尿动力学及经直肠超声检查,根据是否明确膀胱出口梗阻(BOO+)及测得前列腺体积决定是否进行手术以及选择手术方式,术后1个月复查尿动力学检查评估尿道及膀胱功能。结果根据尿动力检查有明确膀胱出口梗阻(BOO+)者129例、可疑膀胱出口梗阻(BOO+-)者17例、无膀胱出口梗阻(BOO-)者4例,三组患者在最大尿流率(Qmax)、残余尿量(PVR)、最大尿流率时逼尿肌压(Pdet-Qmax)比较差异均有统计学意义(P<0.05)。对21例BOO+-和BOO-者采取保守治疗,21例前列腺体积≥80 ml的BOO+患者选择耻骨上膀胱切开前列腺摘除术治疗,106例前列腺体积<80 ml的BOO+患者选择行经尿道前列腺电切术治疗,术后1个月Qmax、PVR、Pdet-Qmax均较术前明显改善(P<0.05)。结论术前常规行尿动力学联合经直肠超声检查有助于评估患者整个尿路及前列腺情况,并依据评估结果选择相应的治疗方法及手术方式。

Objective To investigate the application of urodynamic examination combined with transrectal ultrasound to preoperative evaluation in benign prostatic hyperplasia. Methods 150 cases of benign prostatic hyperplasia were selected as investigated subject. All cases received urodynamic examination combined with transrectal ultrasound,and decided to operate or select operation method according to bladder outlet obstruction and prostate volume. The function of urethra and bladder were assessed to review urodynamic after a month. Results According to urodynamic examination,the bladder outlet obstruction cleat（VOO ＋ ）were in 129 cases,be suspicious bladder outlet obstruction（VOO ＋ - ） were in 17 cases,and no bladder outlet obstruction（VOO - ）were in 4 cases. There were significant difference in Qmax,PVR,Pdet - Qmax among 3 group（ P 〈 0. 05）. 21 cases of VOO ＋ and VOO - received conservative treatment,21 cases of VOO ＋ with prostate volume ≥80 ml were selection supra - pubis incision prostatectomy,106 cases of VOO ＋ with prostate volume 〈 80 ml were treat for TURP. After a month,Qmax, PVR and Pdet - Qmax were significantly improve than preoperative（ P 〈 0. 05）. Conclusion Urodynamic routine preoperative combined with transrectal ultrasonography can help evaluation the urinary tract and prostate conditions,and based on the assessment results to select the appropriate treatment and surgical method.