前列腺增生血供变化及临床意义

Changes and clinical significance of blood supply to the benign prostatic hyperplasia

目的探讨前列腺增生后的血供变化及前列腺动脉栓塞术的临床意义。方法对2014年1月至2014年12月河南科技大学第一附属医院泌尿外科收治的130例前列腺增生患者进行经直肠超声前列腺检查,测量前列腺大小,以估算出的重量为标准将130例患者分为4组：A组（≤25 g）,B组（26~50 g）,C组（51~75 g）,D组（≥76 g）。测量4组患者尿道前列腺动脉的内径、最大血流速度（V_（max））、脉动指数（PI）、阻力指数（RI）,并进行统计学分析。130例患者中27例行前列腺动脉栓塞术,对比栓塞前后患者尿道前列腺动脉的内径、V_（max）、PI、RI及前列腺重量的变化。结果尿道前列腺动脉的内径、V_（max）、PI、RI等参数比较,4组组内、组间差异均有统计学意义（均P〈0.05）,尿道前列腺动脉的内径、V_（max）、PI、RI等指标与前列腺重量呈正相关。行动脉栓塞术后3个月及1年时复查,尿道前列腺动脉的内径、V_（max）、PI、RI及前列腺重量等指标均明显变小（均P〈0.05）。结论前列腺增生的血液供应明显增加,尿道前列腺动脉血流速度增快,内径增宽,血管阻力增大。阻断尿道前列腺动脉能使前列腺增生组织的血供明显减少,并可使前列腺体积缩小,有利于缓解下尿路梗阻。

Objective To study the changes of blood supply to the benign prostatic hyperplasia and the significance of the prostatic artery embolization. Methods 130 patients were chosen to take transrectal ultrasound examination and measure the prostate weight. The patients then were divided into four groups by prostate weight：（ ≤25g）,（ 26 ~ 50g）,（ 51 ~ 75g）,（ ≥76g）. The measured parameters of the urethral artery of prostate were the inner diameter,the maximum of flow velocity（ Vmax）,the pulsatility index（ PI） and the resistance index（ RI）,and they were analyzed statistically. Inner diameter,Vmax,PI,RI,and prostate weight of the27 patients before and after transurethral prostatic artery embolization were contrasted. Results Inner diameter,Vmax,PI and RI of the prostatic urethra arteries were compared. There were significant differences both in group and between groups（ P〈 0. 05）,and the inner diameter,Vmax,PI,RI of the prostatic urethra arteries were correlated positively with prostate weight. After prostate artery embolization,the inner diameter,Vmax,PI,RI,and the prostate weight were significantly lighter,the difference was statistically significant（ P 0. 05）.Conclusion The blood supply of benign prostatic hyperplasia is significantly increased. The blood flow of transurethral prostatic artery is faster,the inner diameter is wider and the vascular resistance is increasing. Blocking transurethral prostatic artery can significantly reduce the blood supply of benign prostatic hyperplasia,shrink prostate volume,and help releasing the lower urinary tract obstruction.