螺旋形热膨胀前列腺支架置入术26例临床分析

Spiral thermo-expandable prostatic stent implantation for benign prostatic hyperplasia: Clinical analysis of 26 cases

目的:探讨经尿道Memokath新型螺旋形热膨胀前列腺支架置入术的手术经验和临床效果。方法:2017年1月至2018年1月,对26例良性前列腺增生(BPH)患者采用经尿道前列腺支架置入术,其中17例采用硬性膀胱镜,9例患者采用软性膀胱镜。手术患者年龄62~91岁,残余尿(67.3±11.2) ml,最大尿流率(6.3±1.8) ml/s,IPSS评分(26.7±5.7)分,前列腺体积32~78 ml。尿潴留患者8例,6例放置导尿管,2例术前行膀胱造瘘术。结果:2例患者支架脱入膀胱,24例患者手术顺利。手术时间15~30 min,2例患者出现血块膀胱栓塞,22例患者术后立即恢复自主排尿。术后3个月复查,24例患者残余尿(21.4±7.7) ml,最大尿流率(18.3±4.7) ml/s,IPSS评分(8.3±2.1)分。13例患者术前后IIEF-5评分无显著差异[(14.1±1.1)分vs(14.3±1.0)分]。随访1年,2例患者反复出现尿路感染,其余患者无明显不良反应,所有24例患者排尿功能改善良好。结论:Memokath新型螺旋形热膨胀前列腺支架置入术手术简便、安全性高、疗效确切、不影响性功能。随访1年并发症少,是一种新型的治疗BPH的有效治疗方案。

Objective: To investigate the surgical techniques and clinical effect of Memokath transurethral spiral thermo-expandable prostatic stent ( STEPS) implantation in the treatment of BPH. Methods: From January 2017 to January 2018 , 26 BPH patients underwent Memokath transurethral STEPS implantation, 9 under the flexible cystoscope and the other 17 under the rigid cystoscope. The patients were aged 62-91 years old, with a prostate volume of 32 - 78 ml, postvoid residual urine volume ( PVR) of (67. 3 ±11.2) ml, maximum urinary flow rate ( Qmax) of (6.3±1.8) ml/s, and IPSS score of 26. 7± 5.7. Eight of the patients had preoperative urinary retention, of whom, 6 received catheterization and 2 had undergone cystostomy for bladder fistula before STEPS implantation. Results: The operations lasted 15-30 minutes and were successfully completed in 24 cases while stent-shedding occurred in the other 2. Twenty-two of the patients achieved spontaneous urination immediately after surgery and 2 experienced bladder clot embolism. At 3 month after surgery, 24 of the patients showed significant improvement in PVR ([21.4 ±7. 7] ml), Qmax ([ 18. 3 ± 4. 7] ml/s) and IPSS (8. 3 ± 2. 1 ), and 13 exhibited no statistically significant difference from the baseline in the IIEF-5 score (14. 1 ± 1.1 vs 14. 3 ± 1.0, P > 0. 05). At 12 months, all the patients were found with markedly improved urination but no adverse events except recurrent urinary tract infection in 2 cases. Conclusion : Memokath STEPS implantation, with its advantages of simple operation, high safety, definite effectiveness, non-influence on sexual function, is a new effective surgical option for the treatment of BPH.