术前B超检查参数在预测经尿道前列腺切除术疗效中的价值

Predictive value of postoperative ultrasonographic parameters regarding the outcome after TURP for patients with symptomatic BPH

目的 探讨术前B超检查参数在预测经尿道前列腺切除术（TURP）疗效中的价值.方法 前瞻性纳入2009年3月至2010年12月202例症状性良性前列腺增生（symptomatic BPH,sBPH）患者,年龄（65.5±8.1）岁.国际前列腺症状评分（IPSS）为16.6±8.1,生命质量（QOL）评分为5（3,6）.术前B超及尿动力学联合检查结果：前列腺体积（total prostate volume,TPV）为（7 5.0±38.5） ml,移行区体积（transitional zone volumn,TZV）为（49.9±32.4）ml,移行区指数（transitional zone index,TZI）为0.59±0.14,前列腺突入膀胱长度（intravesical prostatic protrusion,IPP）为（17.2±5.0）mm,前列腺内腺血流阻力指数（resistive index,RI）为0.63 ±0.12,残余尿量（postvoiding residue,PVR）为（132.7 ±97.8）ml,逼尿肌厚度（detrusor wall index,DWT）为（16.3 ±7.9） mm,B超测量膀胱质量（ultrasonic estimation of bladder weight,UEBW）为（44.8±7.1）g,最大尿流率（Qmax）为（6.1±6.0） ml/s.202例均接受同一治疗组进行的TURP.术后6个月随访,根据IPSS、QOL及Qmax恢复程度将患者分为无效、一般、良好、优秀4个等级,以及有效和无效两组.利用Logistic回归及受试者工作特征（receiver operating characteristic,ROC）曲线从B超测量参数中挑选出影响TURP疗效的独立危险因素,评估利用其预测TURP疗效的效力.结果 有效组149例,术前TZI为0.65 ±0.27、IPP为（18.3 ±3.1）mm、RI为0.77 ±0.18、DWT为（19.0 ±5.0）mm、UEBW为（46.6±7.1）g;无效组53例,术前TZI为0.58±0.19、IPP为（15.9±5.6） mm、RI为0.59 ±0.17、DWT为（13.2 ±8.1）mm、UEBW为（40.8±9.6）g,两组比较差异均有统计学意义（P＜0.05）.多变量分析结果示RI、DWT及UEBW过低为TURP疗效不满意的独立危险因素（P＜0.05）,RI、DWT及UEBW的ROC曲线下面积分别为0.816、0.732及0.723,提示在预测TURP疗效方面具有满意效力;3项参数的联合阳性预测值达到96.3％.结论 术前B超检查测量RI、DWT及UEBW在预测TURP疗效方面具有应用价值,可以利用这些参数对拟行TURP的sBPH患者做出筛选.

Objective To evaluate the value of preoperative ultrasonographic parameters in predicting the outcome of TURP.Methods A total of 202 patients with symptomatic benign prostatic hyperplasia （sBPH） entering our department for surgical therapy were prospectively recruited,with mean age of （65.5 ± 8.1） years,international prostate symptom score （IPSS） of 16.6 ± 8.1 and quality of life （QOL） score of 5 （3,6）.Preoperative combined test of ultrasonography and urodynamics has found total prostate volume （TPV）,transitional zone volume （TZV）,transitional zone index （TZI）,intravesical prostatic protrusion （IPP）,resistive index （RI）,postvoiding residue （PVR）,detrusor wall index （DWT）,ultrasonic estimation of bladder weight （UEBW） and maximum flow rate （Qmax） to be （75.0 ±38.5） ml,（49.9 ± 32.4） ml,0.59 ±0.14,（17.2 ±5.0） mm,0.63 ±0.12,（132.7 ±97.8）ml,（16.3 ±7.9）mm,（44.8 ± 7.1）g and （6.1 ± 6.0）ml/s respectively.A 6-monthsfollow-up after standard TURP were applied including re-measurement of IPSS,QOL score and Qmax.The patients were classified into 2 groups of effective and ineffective after the recovery being stratified into 4 levels of none,fair,good and excellent.The influence of preoperative ultrasonographic parameters on surgical outcome was analyzed by logistic regression and receiver operating characteristic （ROC） curve.Results The group of effective has 149 patients,with the preoperative TZI,IPP,RI,DWT and UEBW of 0.65 ± 0.27,（18.3 ± 3.1） mm,0.77 ± 0.18,（19.0 ± 5.0） mm and （46.6 ± 7.1） g,which were significantly higher than that of the group of ineffective （P 〈 0.05） Lower RI,DWT and UEBW were found to be risk factors of unfavorable surgical efficacy （P 〈 0.05） from multivariable analysis.The area under curve （AUC） of RI,DWT and UEBW in outcome prediction was 0.816,0.732 and 0.723 respectively from ROC curve,indicating the good predictive value of the 3 parameters with combined positive predictive value （PPV） of 96.3%.Conclusion RI,DWT and UEBW have favorable value in predicting TURP outcome.Measuring these parameters by preoperative ultrasonography might aid in determining the need for surgical intervention in sBPH patients.