前列腺动脉栓塞治疗高危前列腺增生症合并急性尿潴留

Prostatic Artery Embolization for the Treatment of Benign Prostatic Hyperplasia Associated with Acute Urinary Retention

目的评价前列腺动脉栓塞术（PAE）治疗高危前列腺增生症（BPH）合并急性尿潴留（AUR）的操作技术、疗效及安全性。方法采用聚乙烯醇及明胶海绵颗粒栓塞患者前列腺动脉,观察患者术后排尿通畅情况,比较手术前后国际症状评分（IPSS）、生活质量评分（QOL）、前列腺体积变化情况。结果 24例患者中,23例成功接受栓塞治疗,12例患者术后1～2周内成功拔除尿管,在6～24个月随访中排尿保持通畅,有效率52.2%。术前、术后患者IPSS、QOL、前列腺体积分别为23.1±2.42、4.7±0.70、（124±7.21）cm3和17±2.11、2.3±0.61、（89±3.43）cm3,差别有统计学意义。无围手术期大出血、感染、死亡等严重并发症。结论 PAE治疗高危BPH伴尿潴留有一定疗效,是一种安全的治疗方法,但应注意选择适应证及手术技巧。

Objective To evaluate the effect and safety of prostatic arterial embolization （PAE） in treating benign prostatic hyperplasia complicated by acute urinary retention for patients with high operation risk. Methods Using polyvi- nyl alcohol and gelatin sponge as embolic agents, the embolization of prostatic arteries was performed in all patients. After the procedure, the improvement of urination was recorded, and the postoperative international prostate symptom score （ IPSS） , quality of life （QOL） as well as the volume of prostate were compared with those obtained before operation. Results A total of 24 patients were included in this study. PAE was successfully accomplished in 23 patients （95.8%）. Urethral catheter was removed in 12 patients （ 12/23 ） within 1 - 2 weeks after the treatment. The urinary tract remained patent in 6 -24 months. The effective rate was 52.2%. The preoperative IPSS, QOL and volume of prostate were 23.1± 2.42, 4.7± 0.70 and （ 124 ±7.21 ） cm3 respectively, and the postoperative IPSS, QOL and volume of prostate were 17 ± 2.11,2.3 ±0.61 and （89 ±3.43） cm3 respectively; the differences were statistically significant. No serious complication such as hemorrhage, infection, death, etc. occurred. Conclusion PAE is a safe and effective procedure for BPH complicated by urinary retention for patients with at high operation-related risk, but attention should be paid to the selection of indication and technical skill