经尿道前列腺电切术中切除的组织大小对术后近期疗效的分析

Resected prostate tissue volume and postoperative short-term outcomes of transurethral resection of the prostate

目的:评估切除的前列腺组织的体积(RPV)对经尿道前列腺电切术(TURP)术后国际前列腺症状评分(IPSS)、生活质量(Qo L)评分及排尿功能的影响。方法:2012年1月至2014年12月接受TURP手术、术后病理证实为BPH的患者82例,分析术前及术后3个月患者IPSS、Qo L、残余尿量(PVR)以及最大尿流率(Qmax)的变化。术前通过超声测定前列腺总体积(TPV)和移行带体积(TZV),分析RPV以及RPV/TPV和RPV/TZV对TURP效果的影响。结果:TURP术后3个月,Qmax平均增加9.27 ml/s,IPSS平均降低15.86分,Qo L平均增加3.47分,PVR平均降低87.1 ml。患者术后效果满意率为72.0%。术后效果明显组术后IPSS、Qo L均显著低于效果不满意组[(4.47±3.92)分vs(8.93±7.13)分,(0.91±0.87)分vs(1.95±1.28)分,P均<0.01],Qmax显著增加[(20.52±8.54)ml/s vs(11.17±2.86)ml/s,P<0.01],而PVR无显著差异[(29.50±18.30)ml vs(39.10±48.20)ml,P=0.192]。术后效果明显组患者与效果不满意组患者相比,术中RPV变化无明显差异,RPV/TPV和RPV/TZV在术后效果明显组中显著高于效果不满意组(P=0.002和P=0.004)。RPV/TPV和RPV/TZV在预测术后疗效的ROC曲线下面积分别为0.793和0.687(P=0.001和P=0.009)。结论:TURP近期随访疗效与术中前列腺组织切除比例密切相关,RPV/TPV和RPV/TZV可能成为术后预测TURP疗效的新指标。

Objective： To evaluate the influence of the resected prostate tissue volume （RPV） on the improvement of Interna- tional Prostate Symptom Score （ IPSS ）, quality of life （ QOL ） , and voiding function after transurethral resection of the prostate （TURP）. Methods： This study included 82 men with benign prostatic hyperplasia treated by TURP. Before and three months after TURP, we obtained the IPSS, QOL score, post-voiding residual urine volume （PVR） , and maximum urinary flow rate （Qmax） from the patients. We measured the total prostate volume （TPV） and transition zone volume （TZV） by transrectal ultrasound preoperatively and investigate the influence of the RPV, RPV/TZV ratio, and RPV/TPV ratio on the efficiency of TURP. Results ： At three months after TURP, the mean Qmax increased by 9.27 mL/s, IPSS decreased by 15.86, QOL score increased by 3.47, PVR decreased by 87.1 ml, and 72.0% of the patients felt satisfied with the surgical results. There was no statistically significant difference in RPV be- tween the patients satisfied and those dissatisfied with the results. Both the RPV/TPV and RPV/TZV ratios significantly increased inthe satisfaction group as compared with the dissatisfaction group （P = 0. 002 and P = 0. 004）. The areas under the ROC curve for the RPV/TPV and RPV/TZV ratios were 0.793 （P=0.001） and 0.687 （P=0.009）, respectively. Conclusion： RPV is closely relat- ed to the short-term outcomes of TURP, and the ratios of RPV/TPV and RPV/TZV may be used as new markers to predict the out- comes of TURP.