网状支架治疗前列腺增生的远期疗效观察

Long term outcome of benign prostatic hyperplasia treated with endourethral wallstent

目的 :观察网状支架治疗良性前列腺增生 (BPH)的临床效果。方法 :对 36例BPH患者放置网状支架进行治疗 ,并分别于治疗后 6、12、2 4、4 8～ 6 0个月进行随访。结果 :全部患者术后均恢复排尿 ,早期有膀胱刺激征和血尿。获 2年以上随访的 17例患者 ,国际前列腺症状评分 (IPSS)从术前 2 8.6± 6 .2分减小至 6 .3± 3.9分 (P<0 .0 0 1) ,平均尿流率 (AFR)从术前 6 .8± 3.2ml s增加至 13.6± 6 .2ml s(P <0 .0 0 1) ,剩余尿量 (RUV)从术前15 6± 2 3.4ml减小至 4 2 .6± 30 .2ml(P <0 .0 0 1)。随访 4 8～ 6 0个月的 8例患者发生尿潴留 ,其中 3例作开放手术切除前列腺 ,1例拔除支架管后行前列腺电切术 ,另 4例行膀胱穿刺造瘘。结论 :网状支架是高危BPH患者的一种安全有效的近期治疗方法 ;放置支架管时间过长 ,可再次出现尿潴留 。

Purpose:To observe the clinical results of benign prostatic hyperplasia treated by endourethral wallstent. Methods:36 BPH patients at high surgical risk were treated by endourethral wallstent. The patients were followed up at 6,12,24, 48 to 60 months after being implanted. Results:All cases resumed urinating after operation . Irritative symptoms and hematuria were noted early in all cases. 17 cases were followed up after being implanted during two years, IPSS decreased from 28.6 ± 6.2 to 6.3 ± 3.9 (P< 0.001 ), AFR increased from 6.8 ± 3.2 to 13.6 ± 6.2 ml/s (P< 0.001 ) and residual urine decreased from 156±2 3.4 to 42.6 ± 30.2 ml (P< 0.001 ). 8 cases had retention of urine during 48 to 60 months and 3 of these patients were performed surgical enucleation, One case was conducted to transurethral resection after the stent had been pulled out, the 4 others was performed cystostomy. Conclusions:Treatment with endourethral wallstent offers a safe and effective alternative therapy for high risk patients with BPH. Urinary retention may occur once again after a long time of stent implantation; the patients need to be properly coped with according to physical conditions.