体外冲击波辅助治疗Ⅲ型前列腺炎的临床效果观察

Efficacy of adjuvant extracorporeal shock wave treatment for type Ⅲ prostatitis

目的评估辅助体外冲击波治疗(ESWT)Ⅲ型前列腺炎的临床效果。方法顺序收集了2015年9月至2016年12月在川北医学院附属医院泌尿外科确诊为Ⅲ型前列腺炎患者125例,先予以患者指南推荐的标准药物治疗方案4周,治愈患者(76例)退出临床观察,未治愈49例患者中36例患者除药物治疗外再辅助体外冲击波治疗(辅助ESWT组),13例患者继续药物治疗(药物治疗组)。应用慢性前列腺症状指数(CPSI)、国际前列腺症状评分(IPSS)以及数字疼痛评分量表(NRS-11)来评价治疗前后前列腺炎相关症状的恢复情况。采用t检验比较药物治疗组与辅助ESWT组上述指标的组间差异以及组内差异,采用χ2检验比较药物治疗组与辅助ESWT组治愈率的差异。结果辅助ESWT组继续治疗4周后的CPSI、IPSS评分及NRS-11评分较治疗前均下降[(11.25±5.82)分vs(29.17±4.29)分;(5.75±3.95)分vs(13.69±3.47)分;(2.19±1.58)分vs(5.06±0.89)分,且差异具有统计学意义(t=14.57,9.46,9.04,P均<0.01);药物治疗组治疗后CPSI、IPSS评分以及NRS-11评分较治疗前下降(19.31±7.40)分vs(28.85±4.02)分;(8.54±3.84)分vs(11.69±2.50)分;(4.08±1.98)分vs(4.77±0.93)分],CPSI评分比较差异具有统计学意义(t=5.06,P<0.01),但IPSS和NRS-11评分比较差异无统计学意义(t=1.99,P=0.07;t=1.24,P=0.24)。以CPSI评分<9分综合评价前列腺炎相关症状恢复情况,药物治疗组治愈率低于辅助ESWT组(23.08%vs80.56%),2组比较差异具有统计学意义(χ2=13.93,P<0.01);以IPSS评分<7分为患者排尿症状治愈标准评价,药物治疗组治愈率低于辅助ESWT组(61.54%vs 69.44%),2组比较差异无统计学意义(χ2=0.27,P=0.60);以NRS-11评分<3分为疼痛症状治愈标准评价,药物治疗组治愈率低于辅助ESWT组(30.77%vs 72.22%),2组比较差异具有统计学意义(χ2=6.91,P=0.01)。2组患者均未出现明显并发症。结论辅助ESWT能明显提高Ⅲ型前列腺炎治愈率,与药物治疗有协同增效作用,特别是对患者疼痛症状的缓解有明显作用,同时也有较好的安全性。

Objective To evaluate the clinical efficacy of adjuvant extracorporeal shock wave therapy(ESWT)for typeⅢprostatitis.Methods One hundred and twenty-five patients with typeⅢprostatitis diagnosed at Department of Urology of North Sichuan Medical College from September 2015 to December 2016 were sequentially collected.These patients initially received guideline recommended standard drug treatment for 4 weeks.After that,the cured patients(76 cases)were excluded from clinical observation,and the remaining uncured 49 patients continued to receive treatment,of whom 36 received drug treatment and adjuvant ESWT and 13 continued to receive drug therapy alone.NIH-CPSI,IPSS,and NRS-11 scales were used to evaluate the prostatitis-related symptoms before and after treatment.The t-test was used to compare the differences between groups.The difference in cure rates between groups was compared using the chi-square test.Results After treatment,CPSI,IPSS,and NRS-11 scores in the ESWT-treated group were significantly lower than the scores before treatment[(11.25±5.82)vs(29.17±4.29),(5.75±3.95)vs(13.69±3.47),(2.19±1.58)vs(5.06±0.89);t=14.57,9.46,9.04,P<0.01 for all];however,although CPSI,IPSS,and NRS-11 scores decreased in the drug treatment alone group compared with the values before treatment[(19.31±7.40)vs(28.85±4.02),(8.54±3.84)vs(11.69±2.50),(4.08±1.98)vs(4.77±0.93)],only CPSI scores were statistically different(t=5.06,P<0.01)and there was no significant difference in IPSS or NRS-11 scores(t=1.99,P=0.07;t=1.24,P=0.24).Comprehensive evaluation of prostatitis-related symptoms using CPSI score<9 as a threshold showed that the cure rate in the drug treatment alone group was significantly lower than that in the adjuvant ESWT group(23.08%vs 80.56%),χ2=13.93,P<0.01).Using IPSS score<7 as the cure standard for patients with urinary symptoms,the cure rate was lower in the drug treatment alone group than in the adjuvant ESWT group(61.54%vs 69.44%),but there was no significant difference between the two groups(χ2=0.27,P=0.60).When using NRS-11 score<3 as the cure standard for patients with pain symptoms,the cure rate was significantly lower in the drug treatment alone group than in the adjuvant ESWT group(30.77%vs 72.22%,χ2=6.91,P=0.01).There were no significant difference in complications between the two groups.Conclusion Adjuvant ESWT for typeⅢprostatitis can significantly improve the cure rate and have a synergistic effect with drug therapy,especially for the relief of pain symptoms.