良性前列腺增生症不同术式术后疗效不良原因的研究

Non-improvement after different procedures of prostatectomy

目的 探讨良性前列腺增生症 (BPH)不同术式术后疗效不良的原因及特点 ,进一步提高手术成功率。 方法 应用尿动力学检测及其他检查手段对 84例BPH术后症状改善不良的患者按手术方式的不同分组进行检查分析。 结果 尿道前列腺电切术组术后改善不良的主要原因依次为膀胱出口再梗阻 (84 9% )、逼尿肌收缩无力 (3 0 4% )和逼尿肌不稳定 (DI) (18 2 % )。开放组主要原因依次为逼尿肌收缩无力 (5 2 9% )、逼尿肌不稳定 (3 5 2 % )和膀胱出口再梗阻 (3 3 3 % )。 2组数据经χ2 检验差异有显著性意义 (P =0 0 0 0 )。 结论 不同手术方式 ,其术后疗效不良原因差异有显著性。TURP组再梗阻率远高于开放组 ,在一定程度上反映目前TURP手术技术有待进一步提高。术前存在逼尿肌收缩无力和DI。

Objective To analyze the causes of non improvement after different procedures of prostatectomy. Methods Using the urodynamics and other techniques, we examined 84 non improved patients who had undergone different procedures of prostateclomy. Results In the TURP group, the main causes of non improvement included bladder outlet obstruction(84.9%), weak contractility of the detrusor (30 4%), and detrusor instability (DI) (18 2%). In the open group, however, the main causes of non improvement included detrusor weak contractility (52 9%)、DI (35 2%), and bladder outlet obstruction(33 3%). There was significant difference between the two groups according to the Pearson Chi sqpuare test ( P =0 000).The reobstruction rate in the TURP group was much higher than that in the open group, suggesting that the level of the TURP should be improved. Conclusions Different operative procedures yield different non improvement after prostatectomy gradually. When BPH patients are diagnosed with detrusor weak contractiliy and DI, prostatectomy shoud be carefully considered.