前列腺总体积及移行带体积对良性前列腺增生症经尿道前列腺电切术疗效的影响

Effect of total prostate volume and transitional zone volume on the curative effect of transurethral resection of prostate in benign prostatic hyperplasia

目的比较不同前列腺总体积(TPV)及不同前列腺移行带体积(TZV)对良性前列腺增生症(BPH)患者采用经尿道前列腺电切术(TURP)治疗的临床效果。方法回顾性收集2016年6月至2018年8月贵州省人民医院收治的210例BPH患者的临床资料并进行分析研究。所有患者均行经直肠前列腺超声检查,根据TPV分成3组:A组TPV<40 ml者70例,B组40 ml≤TPV<80 ml者98例,C组TPV≥80 ml者42例;同时据TZV分组:a组88例:TZV<20 ml,b组67例:20 ml≤TZV<40 ml,c组55例:TZV≥40 ml。所有患者均行TURP治疗,术后随访6个月,统计手术前后国际前列腺症状评分(IPSS)、排尿期IPSS(IPSS-V)、储尿期IPSS(IPSS-S)、生活质量评分(QoL)以及最大尿流率(Qmax),使用方差分析分别分析TPV及TZV对TURP疗效的影响。结果A、B、C 3组患者术前IPSS、IPSS-V、IPSS-S、QOL、Qmax差异均无统计学意义(均P>0.05),但C组患者年龄(73.5±6.5)岁明显大于A组的(69.3±7.6)岁及B组的(70.9±7.3)岁(P=0.015)。A、B、C 3组患者术后IPSS、IPSS-V、IPSS-S、QoL及Qmax比较差异无统计学意义(均P>0.05)。a、b、c 3组患者术前IPSS、IPSS-V、IPSS-S、QoL、Qmax差异均无统计学意义(均P>0.05),而a组年龄(69.2±7.6)岁明显小于b组的(72.1±7.2)岁及c组的(72.5±6.7)岁(P=0.017)。a、b、c 3组患者术后IPSS、IPSS-V、IPSS-S、QoL及Qmax比较差异均有统计学意义(均P<0.05),且IPSS、IPSS-V、IPSS-S、QoL与TZV呈负相关,而Qmax与TZV呈正向相关。A、B、C及a、b、c各组患者术后IPSS、IPSS-V、IPSS-S、QoL及Qmax与术前比较差异均有统计学意义(均P<0.001)。结论TPV、TZV与BPH症状可能无明显相关性,但与年龄可能存在相关。TURP是不同TPV、不同TZV患者的一种有效治疗方式,不同TPV患者手术疗效差异无明显统计学意义,但TZV越大者越趋向于更好的疗效,TZV对术后疗效预测较TPV可能更好。

Objective To compare the clinical effect of different total prostate volume(TPV)and different transitional zone volume(TZV)on benign prostatic hyperplasia(BPH)treated with transurethral resection of prostate(TURP).Methods Clinical data of 210 patients with BPH admitted to Guizhou provincial people′s hospital from June 2016 to August 2018 were retrospectively collected and analyzed.All patients underwent transrectal ultrasonography,and they were divided into three groups according to TPV:70 patients in group A:TPV<40mL,98 patients in group B:40 ml≤TPV<80 ml,and 42 patients in group C:TPV≥80 ml.Meanwhile,three groups were divided according to TZV:88 patients in group a:TZV<20ml,67 patients in group b:20 ml≤TZV<40 ml,and 55 patients in group c:TZV≥40 ml.All of the patients with TURP were followed up for 6 months after surgery,and the data of international prostate symptom score(IPSS),storage symptoms IPSS(IPSS-S),voiding symptoms IPSS(IPSS-V),Quality of Life(QoL)index,and maximum urinary flow rate(Qmax)were collected before and after surgery.Finally,the effect of TPV and TZV on TURP was analyzed respectively by analysis of variance.Results There were no statistically significant differences in preoperative IPSS,IPSS-V,IPSS-S,QoL and Qmax among the three groups of patients grouped by TPV(P>0.05),but the age of patients in group C(73.5±6.5)was significantly higher than that in group A(69.3±7.6)and group B(70.9±7.3)(P=0.015).Postoperative IPSS,IPSS-V,IPSS-S,QoL and Qmax of patients in groups A,B and C also showed no significant difference(P>0.05).There were no statistically significant differences in preoperative IPSS,IPSS-V,IPSS-S,QoL,and Qmax among the three groups of patients grouped according to TZV(P>0.05),while the age of patients in group a(69.2±7.6)was significantly lower than that of patients in group b(72.1±7.2)and group c(72.5±6.7)(P=0.017).There were statistically significant differences in IPSS(P=0.010),IPSS-V(P=0.037),IPSS-S(P=0.022),QoL(P=0.038)and Qmax(P=0.037)among the groups a,b,and c after surgery.Moreover,IPSS,IPSS-V,IPSS-S and QoL were negatively correlated with TZV,while Qmax was positively correlated with TZV.Postoperative IPSS,IPSS-V,IPSS-S,QoL and Qmax were significantly different from those before surgery in groups A,B,C and groups a,b,c(P<0.001).Conclusion TPV and TZV may not be significantly correlated with BPH symptoms,but may be correlated with age.TURP is an effective treatment for patients with different TPV and TZV.There is no significant statistical difference in the surgical efficacy among patients with different TPV,but patients with larger TZV tended to have better outcome.TZV may be better than TPV in predicting the postoperative efficacy.