PAE联合TURP与单纯TURP治疗体积≥80 ml的良性前列腺增生症的效果对比及对术后性功能的影响

PAE combined with TURP versus TURP in treatment of≥80 ml benign prostatic hyperplasia and their effects on postoperative sexual function

目的探讨超选择性前列腺动脉栓塞(prostatic arterial embolization,PAE)联合经尿道前列腺电切术(transurethral resection of the prostate,TURP)与单纯TURP治疗体积≥80 ml的良性前列腺增生症(benign prostatic hyperplasia,BPH)的效果及对患者术后性功能的影响。方法回顾性分析2016年10月至2019年10月198例体积≥80 ml的BPH患者资料;其中88例选择单纯TURP治疗,设为对照组[年龄(55.81±5.18)岁];另110例选择PAE联合TURP治疗,设为观察组[年龄(55.58±5.22)岁]。观察两组围术期指标[手术时间、术中出血量、腺体切除体积、前列腺组织切除效率、膀胱冲洗时间、留置尿管时间及术后住院天数]、术后并发症、术后膀胱痉挛情况、术前及术后1个月尿动力学变化和术前与术后1年前列腺症状情况、生活质量及性格评分变化。结果观察组手术时间显著短于对照组[(75.59±18.26)min比(103.26±27.26)min,P<0.05],术中出血量显著少于对照组[(122.26±33.25)ml比(442.66±180.26)ml,P<0.05],腺体切除体积显著多于对照组[(99.26±15.26)g比(78.26±21.05)g,P<0.05],前列腺组织切除效率显著快于对照组[(76.26±15.61)g/h比(41.26±9.26)g/h,P<0.05],膀胱冲洗时间与留置尿管时间显著短于对照组[(1.46±0.51)h比(2.24±0.89)h、(2.21±0.62)d比(3.15±0.88)d,均P<0.05];观察组并发症总发生率为2.73%(3/110),显著低于对照组的10.23%(9/88)(P<0.05)。术后1个月,两组最大尿流速及最大逼尿肌压力较术前显著提高[观察组(15.02±3.89)ml/s比(5.92±1.88)ml/s、(61.02±8.62)cmH2O(1 cmH2O=98 Pa)比(38.66±6.12)cmH2O;对照组(12.23±2.26)ml/s比(6.12±1.92)ml/s、(55.02±7.85)cmH2O比(39.18±6.25)cmH2O;均P<0.05],且观察组显著高于对照组(均P<0.05),残余尿量较术前显著减少[观察组(53.18±10.15)ml比(78.66±23.25)ml,对照组(62.36±12.12)ml比(78.15±23.51)ml,均P<0.05],观察组显著少于对照组(P<0.05)。观察组术后膀胱痉挛发生次数显著多于对照组[(85.26±15.26)次比(65.26±10.64)次,P<0.05],膀胱痉挛持续时间显著长于对照组[(6.12±2.56)min比(3.56±1.19)min,P<0.05],膀胱痉挛疼痛评分显高低于对照组[(4.12±1.19)分比(2.85±0.56)分,P<0.05]。术后1年,两组国际前列腺症状评分、生活质量评分显著低于术前[观察组(6.95±1.52)比(23.12±6.26)、(2.36±0.52)比(4.59±0.83),对照组(7.08±1.63)比(23.21±6.35)、(2.41±0.58)比(4.72±0.86),均P<0.05],两组性功能评分显著高于术前[观察组(2.56±0.38)比(1.42±0.52),对照组(2.52±0.40)比(1.41±0.51),均P<0.05],组间术后1年对比,差异均无统计学意义(均P>0.05)。结论PAE联合TURP治疗体积≥80 ml的BPH患者疗效确切,具有手术时间短、术中出血量少、腺体切除更为彻底、手术效率高、膀胱冲洗时间与留置尿管短、术后并发症少等特点,改善患者术后尿动力学,效果优于单纯TURP治疗,但术后膀胱痉挛程度相对强烈,对于远期前列腺症状、生活质量和性功能的改善与单纯TURP相比,并不具有优势。

Objective To investigate the effects of super-selective prostatic arterial embolization(PAE)combined with transurethral resection of the prostate(TURP)versus TURP in the treatment of≥80 ml benign prostatic hyperplasia(BPH)and their effects on postoperative sexual function.Methods The data of 198 patients with≥80 ml BPH treated at our hospital from October,2016 to October,2019 were retrospectively analyzed.Among them,eighty-eight(55.81±5.18)years old patients who were treated by TURP were set as a control group,and the other one hundred and ten(55.58±5.22)years old patients who were treated by PAE and TURP were set as an observation group.The perioperative indicators[surgical time,intraoperative blood loss,volume of gland resection,efficiency of prostatectomy,bladder irrigation time,urinary catheter indwelling time,and postoperative hospital stay],postoperative complications and bladder spasm,urodynamic changes before surgery and 1 month after surgery,and scores of prostate symptoms,quality of life,and personality before and 1 year after surgery were observed in the two groups.Results The surgical time,bladder irrigation time,and urinary catheter indwelling time were significantly shorter,the intraoperative blood loss was significantly less,the volume of gland resection was significantly heavier,the efficiency of prostatectomy was significantly faster,and the total incidence of complications was significantly lower in the observation group than in the control group[(75.59±18.26)min vs.(103.26±27.26)min,(1.46±0.51)h vs.(2.24±0.89)h,(2.21±0.62)d vs.(3.15±0.88)d,(122.26±33.25)ml vs.(442.66±180.26)ml,(99.26±15.26)g vs.(78.26±21.05)g,(76.26±15.61)g/h vs.(41.26±9.26)g/h,and 2.73%(3/110)vs.10.23%(9/88);all P<0.05].The maximum urinary flow rate and maximum detrusor pressure were significantly higher one month after than before the surgery in the observation group[(15.02±3.89)ml/s vs.(5.92±1.88)ml/s and(61.02±8.62)cmH2O(1 cmH2O=98 Pa)vs.(38.66±6.12)cmH2O;both P<0.05]and in the control group[(12.23±2.26)ml/s vs.(6.12±1.92)ml/s and(55.02±7.85)cmH2O vs.(39.18±6.25)cmH2O;both P<0.05],and were higher in the observation group than in the control group one month after the surgery(both P<0.05).The post-void residual volume was significantly lower one month after than before the surgery in the observation group[(53.18±10.15)ml vs.(78.66±23.25)ml;P<0.05]and in the control group[(62.36±12.12)ml vs.(78.15±23.51)ml;P<0.05],and was significantly lower in the observation group than in the control group one month after the surgery(P<0.05).The frequency of postoperative bladder spasm and the pain score of bladder spasm were higher and the duration of bladder spasm was significantly longer in the observation group than in the control group[(85.26±15.26)times vs.(65.26±10.64)times,(4.12±1.19)vs.(2.85±0.56),and(6.12±2.56)min vs.(3.56±1.19)min;all P<0.05].The International Prostate Symptom Score and Quality of Life Score were significantly lower one year after than before the surgery in the observation group[(6.95±1.52)vs.(23.12±6.26)and(2.36±0.52)vs.(4.59±0.83);both P<0.05]and in the control group[(7.08±1.63)vs.(23.21±6.35)and(2.41±0.58)vs.(4.72±0.86);both P<0.05],but with no statistical differences between these two groups one year after the surgery(both P>0.05).The sexual function score was significantly higher one year after than before the surgery in the observation group[(2.56±0.38)vs.(1.42±0.52);P<0.05]and in the control group[(2.52±0.40)vs.(1.41±0.51);P<0.05],but with no statistical difference between these two groups one year after the surgery(all P>0.05).Conclusions PAE combined with TURP in the treatment of patients with≥80 ml BPH is effective.It has shorter surgical time,less intraoperative blood loss,more thorough gland resection,higher surgical efficiency,shorter bladder irrigation time and urinary catheter indwelling time,and fewer postoperative complications,and can improve postoperative urodynamics.It is more effective than TURP alone,but it has relatively intense postoperative bladder spasm,and it is not superior to TURP alone in improving the patients'long-term prostate symptoms,quality of life,and sexual function.