前列腺动脉栓塞术治疗不同体积良性前列腺增生的对照分析

A comparative study of prostatic artery embolization in the treatment of benign prostatic hyperplasia with different prostatic volume

目的比较前列腺动脉栓塞术(PAE)治疗不同体积良性前列腺增生(BPH)患者的疗效。方法本研究为回顾性、单中心临床研究,收集2015年1月至2017年5月解放军总医院行PAE治疗的137例BPH患者,年龄50~89(70±11)岁,根据前列腺体积分为A组(>80 ml)62例、B组(40~80 ml)47例和C组(<40 ml)28例。比较三组PAE术后1、6、12个月国际前列腺症状评分(IPSS)、生活质量(QoL)评分、最大尿流率(Qmax)等的差异;比较三组PAE术后1个月前列腺缺血比例及术后12个月前列腺体积缩小比例的相关性及二者与IPSS评分、QoL评分的相关性。结果PAE术前,A、B、C三组平均前列腺体积分别为110、67、33 ml。PAE术后12个月,A组IPSS评分及Qmax改善情况均优于B组和C组(均P<0.05)。PAE术后1个月,A、B、C三组前列腺缺血比例分别为61.4%、49.3%、38.0%,A组缺血比例>B组和C组(P=0.049、0.004)。术后12个月,A、B、C三组前列腺体积缩小比例分别为47.3%、29.3%、24.6%,A组前列腺体积缩小比例>B组和C组(均P<0.01)。PAE术后1个月,A、B、C三组前列腺缺血比例均与术后12个月前列腺体积缩小比例呈正相关(r=0.699,P=0.024;r=0.719,P=0.019;r=0.821,P=0.004),二者与术后12个月IPSS评分改善情况呈正相关(0.5<r<1.0;均P<0.05),与QoL改善情况无相关性。结论前列腺体积>80 ml的BPH患者更适合行PAE。PAE术后前列腺缺血比例及前列腺体积缩小比例可预测PAE疗效。

Objective To compare the efficacy of prostatic artery embolization (PAE) in the treatment of patients with benign prostatic hyperplasia (BPH) with different prostatic volume (PV). Methods In this single-center, retrospective study, 137 patients, mean age (70±11) years, range 50-89 years, undergoing PAE for BPH between January 2015 and May 2017 in Chinese PLA General Hospital were involved and divided into three groups according to the PV (group A,>80 ml;group B, 40-80 ml;group C,<40 ml). The changes of international prostate symptoms (IPSS) score, quality of life (QoL) score, and maximum urinary flow rate (Qmax) were compared among the three groups at 1, 6, and 12 months post-PAE. Correlation between the proportion of prostate ischemia at 1 month post-PAE and the proportion of PV reduction at 12 month post-PAE were analyzed, also the correlation between both of them with IPSS and QoL score were analyzed, respectively. Results Mean baseline prostate volumes were 110 ml in group A (n=62), 67 ml in group B (n=47) and 33 ml in group C (n=28). At 12 months post-PAE, the outcomes of IPSS score and Qmax in group A were better than those in group B and C (all P<0.05).The proportion of prostate ischemia at 1 month post-PAE and proportion of PV reduction at 12 month post-PAE in group A, B, and C were 61.4%, 49.3%, 38.0%, and 47.3%, 29.3%, 24.6%, respectively. The proportion of prostate ischemia in group A was larger than that in group B and C (P=0.049, 0.004), also the proportion of PV reduction in group A was greater than that in group B and C (P<0.01). The proportion of prostate ischemia at 1 month post-PAE in all three groups were positively correlated with the proportion of PV reduction at 12 month post-PAE (r=0.699, P=0.024;r=0.719, P=0.019;r=0.821, P=0.004), and there were positive correlations between both of them and the improvement of IPSS score at 12 month post-PAE (0.5<r<1.0, all P<0.05), while no correlation with the improvement of QoL score. Conclusions Patients with BPH with PV larger than 80 ml are more suitable for PAE. The proportion of prostate ischemia and prostate volume reduction after PAE can predict the efficacy of PAE.