小体积良性前列腺增生引起膀胱出口梗阻的手术治疗

Combined transurethral procedure for bladder outlet obstruction induced by small-volume prostatic hyperplasia

目的：探讨经尿道前列腺电切（TURP）＋膀胱颈切开术（TUIBN）治疗小体积良性前列腺增生（BPH）引起的膀胱出口梗阻（BOO）的临床疗效。方法：回顾性分析小体积BPH（〈30 g）56例患者的临床资料,年龄45~71岁,平均59.6岁。临床表现为不同程度的排尿困难,20例既往有慢性前列腺炎史。术前评估包括：国际前列腺症状评分（IPSS）、生活质量评分（QOL）、B超、尿动力学检查和尿道膀胱镜检查。术前均行α受体阻滞剂治疗3~6个月,无明显效果而行TURP＋TUIBN。结果：全部患者术后随访12~24个月。2例（3.57%）于术后1个月出现尿道狭窄,予定期尿道扩张后症状改善;1例（1.79%）于术后3个月出现膀胱颈挛缩,再次行TUIBN症状改善。术后12个月行IPSS评分、尿动力学检查与术前进行比较。术后IPSS评分显著低于术前（12.76±2.37 vs25.54±2.33,P〈0.01）;最大尿流率（Qmax）明显高于术前[（15.83±1.47）ml/s vs（8.47±0.96）ml/s）,P〈0.01];膀胱残余尿较术前明显减少[（31.02±9.75）ml vs（68.07±17.09）ml,P〈0.01]。结论：TURP＋TUIBN治疗小体积BPH引起的BOO效果显著,优于单纯TURP或TUIBN,手术安全,是治疗小体积BPH引起BOO的较理想术式。

Objective： To investigate the clinical effect of transurethral resection of the prostate（TURP） combined with transurethral incision of the bladder neck（ TUIBN） in the treatment of bladder outlet obstruction（ BOO） caused by small-volume benign prostatic hyperplasia（ BPH）. Methods： We retrospectively analyzed the clinical data about 56 cases of small-volume BPH. The patients,aged 45- 71（ mean 59. 6） years,all showed varied degrees of dysuria and 20 of them had a history of chronic prostatitis. Preoperative examinations included the obtainment of International Prostate Symptom Score（ IPSS）,evaluation of the quality of life（QOL）,ultrasonography,urodynamic examination,and cystoscopy. All the patients received alpha-blockers for 3- 6 months without obvious response and therefore underwent TURP ＋ TUIBN. Results： Postoperative follow-up lasted 12- 24 months. Urinary tract stricture was found in 2 cases（3. 57%） at 1 month after surgery,which was improved after urethral dilation,and bladder neck contracture occurred in 1 case（1. 79%） at 3 months,which was relieved by repeated TUIBN. Compared with the baseline,the IPSS was dramatically decreased at 12 months postoperatively（25. 54 ± 2. 33 vs 12. 76 ± 2. 37,P〈0. 01）,and so was the postvoid residual（[68. 07 ± 17. 09]vs [31. 02 ± 9. 75] ml. P〈0. 01）,while the maximum urinary flow rate（Qmax） was significantly increased（[8. 47 ± 0. 96]vs [15. 83 ± 1. 47]ml/s,P〈0. 01）. Conclusion： TURP ＋ TUIBN is superior to either TURP or TUIBN alone in the treatment of BOO induced by small-volume BPH for its higher effectiveness and safety.