术前长期常规剂量和术前短期大剂量非那雄胺在行经尿道前列腺汽化电切术的良性前列腺增生患者中的效果及安全性观察

Effect and safety observation of preoperative long-term conventional-dose and short-term high-dose finasteride in patients with benign prostatic hyperplasia undergoing transsurethral vaporization of the prostate

目的观察长期常规剂量和短期大剂量非那雄胺在行经尿道前列腺汽化电切术(TUVP)患者中的应用效果及安全性。方法选取2018年1月至2021年1月于达州市中心医院行择期TUVP的360例良性前列腺增生(BPH)患者作为研究对象,采用随机数字表法分为A组和B组,各180例。A组术前3个月起服用非那雄胺5mg/d,B组术前1周起服用非那雄胺15mg/d,两组患者均由同一术者实施TUVP。比较两组患者手术完成情况,术中出血情况(前列腺组织切除量、术中出血量、切除每克组织失血量),前列腺组织标本生化检测指标[血管内皮生长因子(VEGF)阳性细胞数、微血管密度(MVD)、细胞凋亡率],术前、术后3个月前列腺功能指标[国际前列腺症状评分(IPSS)、最大尿流率(Qmax)],术后3个月性功能障碍发生情况。结果两组患者均顺利完成手术,无死亡、经尿道电切综合征(TURS)发生;两组患者前列腺组织切除量比较,差异无统计学意义(P>0.05);A组术中出血量、切除每克组织失血量少于B组(P<0.05);A组前列腺组织标本VEGF阳性细胞数、MVD均小于B组,细胞凋亡数大于B组(P<0.05);术后3个月,两组患者IPSS均较术前降低,Qmax较术前提高(P<0.05),但两组比较,差异无统计学意义(P>0.05);术后3个月,两组患者性功能障碍总发生率比较,差异无统计学意义(P>0.05)。结论BPH患者行TUVP术前长期常规剂量应用非那雄胺与短期大剂量应用相比,可更有效地减少术中出血量,但两者对TUVP手术效果及术后性功能恢复的影响无显著差异。

Objective To observe the effect and safety of long-term conventional-dose and short-term high-dose finasteride in the benign prostatic hyperplasia patients before transurethral vaporization of the prostate(TUVP).Methods A total of 360 patients with benign prostatic hyperplasia(BPH)who underwent elective TUVP in Dazhou Central Hospital between January 2018 and January 2021 were enrolled as the research subjects,and were divided into group A and group B by the random number table method,with 180 cases in each group.The group A received 5 mg/d finasteride since 3 months before surgery,and the group B was given 15 mg/d finasteride since 1 week before surgery,and the patients of both groups underwent TUVP surgery by the same surgeon.The surgical completion status,intraoperative bleeding status(the amount of prostate tissue resection,intraoperative bleeding volume,amount of blood loss per gram of tissue resection),biochemical detection indicators of prostate tissue specimens[the number of vascular endothelial growth factor(VEGF)positive cells,microvessel density(MVD),cell apoptosis rate],prostate function indicators[international prostate symptom score(IPSS),maximum urinary flow rate(Qmax)]before surgery and at 3 months after surgery,and occurrence of sexual dysfunction at 3 months after surgery were compared between the two groups.Results Both groups of patients successfully completed the surgery without occurrence of death or transurethral resection syndrome(TURS).There was no statistical difference in the amount of prostate tissue resection between the two groups of patients(P>0.05),and the intraoperative bleeding volume and amount of blood loss per gram of tissue resection in group A were less than those in group B(P<0.05).The number of VEGF positive cells and MVD in prostate tissue specimens of group A were less than those of group B,and the number of cell apoptosis was greater than that of group B(P<0.05).At 3 months after surgery,the IPSS in the two groups was decreased while the Qmax was enhanced compared to before surgery(P<0.05),but there were no statistically significant differences between the two groups(P>0.05).At 3 months after surgery,there was no statistical significance in the total incidence rate of sexual dysfunction between the two groups(P>0.05).Conclusions Compared with short-term high-dose finasteride,the long-term conventional-dose finasteride for patients with BPH before TUVP can more effectively reduce intraoperative bleeding.There are no significant differences in the effects of the two on the TUVP surgical effect and postoperative sexual function recovery.