前列腺动脉介入栓塞术治疗前列腺增生的临床疗效以及血流动力学的影响研究

Study on the Clinical Effect and Hemodynamic Effect of Prostatic Artery Embolization in the Treatment of Prostatic Hyperplasia

目的观察前列腺动脉介入栓塞术治疗前列腺增生(BPH)的临床疗效以及血流动力学的影响。方法随机选取2017年9月-2018年9月确诊为BPH经内科治疗无效且不愿接受传统电切术的43例患者作为治疗组,行前列腺动脉介入栓塞术(PAE);随机选取在该科行前列腺电切术(TURP)的44例患者作为对照组。术后随访3个月,记录比较2组患者国际症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、残余尿(RU)以及前列腺体积的变化;观察比较2组患者治疗前后前列腺动脉的内径(R)、最大血流速度(Vmax)、脉动指数(PI)、阻力指数(RI)等血流动力学指标;观察比较2组患者总体疗效以及并发症发生情况。结果治疗前,2组各项指标均差异无统计学意义(P>0.05)。治疗后,2组患者IPSS、QOL、RU以及前列腺体积均下降,Qmax上升,但与对照组相比,治疗组指标改善更多,差异有统计学差异(P<0.05);治疗后,2组患者血流动力学各项指标(R、Vmax、PI、RI)均下降,但与对照组相比,治疗组指标下降更多,差异有统计学意义(P<0.05);治疗组总体治疗疗效为90.7%,对照组为70.5%(χ^2=5.668,P<0.05);且对照组并发症为18.2%,治疗组为4.7%(χ^2=3.914,P<0.05)。结论与传统TURP相比,使用PAE治疗BPH,可更加有效改善前列腺功能,减少前列腺体积,缓解下尿路梗阻症状,从而增加最大尿流率,另外可明显减少前列腺动脉内径与血供,增加治疗总有效率,且能减少术后并发症的发生,表明PAE治疗BPH更加安全有效,减少术后风险,尤其适用于不愿接受传统电切术的BPH患者,值得临床推广。

Objective To observe the clinical efficacy and hemodynamic effects of prostate artery interventional embolization in the treatment of prostate hyperplasia(BPH). Methods Random select september 2017 to September 2018, a total of 43 patients who were diagnosed as having no effect on BPH after medical treatment and were also unwilling to accept traditional electrotomy were treated as the treatment group and underwent prostate artery interventional embolization(PAE). A total of 44 patients who underwent electroprostatectomy(TURP) in our department were randomly selected as the control group. The patients in the two groups were followed up for 3 months. International symptom score(IPSS), quality of life score(QOL), maximum urine flow rate(Qmax), residual urine(RU) and the change of prostate volume were recorded and compared. The internal diameter(R), maximum blood flow velocity(Vmax), pulse index(PI), resistance index(RI) and other hemodynamic indexes of the prostate arteries of the two groups before and after treatment were observed and compared. The overall efficacy and complications of the two groups were observed and compared. Results Before treatment, there was no statistically significant difference in each index between the two groups(P >0.05). After treatment, IPSS, QOL, RU and prostate volume of the two groups decreased, while Qmax increased. However, compared with the control group, the indicators in the treatment group improved more, and the differences were statistically significant(P<0.05). After treatment, all hemodynamic indexes(R, Vmax, PI, RI) in the two groups decreased. Compared with the control group, the indexes in the treatment group decreased more, and the differences were statistically significant(P<0.05). The overall therapeutic effect was 90.7% in the treatment group, 70.5% in the control group(χ^2=5.668,P<0.05). Complications were 18.2% in the control group, 4.7% in the treatment group(χ^2=3.914,P<0.05). Conclusion Compared with the traditional TURP, the use of PAE in the treatment of BPH can more effectively improve the prostate gland function, reduce the prostate volume, relieve the symptoms of urinary tract obstruction, and increase the maximum urinary flow rate. Additionally, it can obviously reduce the prostate gland artery diameter, blood supply and the occurrence of postoperative complications, and increase the total effective rate. Therefore, the use of PAE in the treatment of BPH is more safe and effective, which can reduce the risk of postoperative. It is especially suitable for the BPH patients who are reluctance to accept the traditional electricity cut method. It is worthy of clinical promotion.