尿流动力学检查结合IPSS评分在分析BPH患者PVP术后疗效作用

Urodynamic studies combined with IPSS score for the analysis of curative effect of green laser surgery on BPH patients

目的:观察中、重度国际前列腺症状评分（IPSS）患者行经尿道选择性绿激光前列腺汽化术（PVP）手术后中期疗效,总结分析术后不良反应发生原因及处理方式,尝试使用IPSS评分评价术后治疗效果。方法:回顾分析2010年1月2012年12月160例IPSS评分大于16分并行PVP治疗的良性前列腺增生症（BPH）患者临床资料,分析其尿流动力学特点,观察手术时间、术中出血、术后留置尿管时间、IPSS、生活质量评分（QOL）、最大尿流率(Qmax)、剩余尿量（RUV）及并发症等指标。术后随访1224个月,总结分析术后不良反应发生原因及处理方式。结果:IPSS评分中度59例、重度101例,平均IPSS（26.5±6.8）分。上述患者均安全度过围手术期,手术时间30147 min,术中无输血病例,术后留置尿管时间25 d。术后IPSS、QOL、Qmax明显改善,RUV【30 ml。术后随访1224个月。随访期间32例患者术后下尿路症状缓解不满意。行尿流动力学检查及尿道镜检查提示:膀胱出口梗阻25例（其中22例前列腺腺体残留,3例膀胱颈口挛缩）,逼尿肌收缩乏力6例（其中假性排尿困难1例）,逼尿肌括约肌协同失调（DSD）1例。结论:PVP是一种治疗中、重度IPSS评分BPH患者的有效方式,手术操作相对简单、出血少、术后并发症少。IPSS评分可量化评估患者手术效果,尿流动力学检查可明确术后疗效不佳原因,评估膀胱功能和逼尿肌稳定性,为临床鉴别诊断、选择合理的治疗方案和估计预后提供依据,对提高疗效具有重要的临床意义。

Objective:To observe the midterm effect of photoselective vaporization of the prostate(PVP) on benign prostate hyperplasia(BPH) patients with midrange or serious IPSS score,and analyse the causes and treatment of postoperative adverse reactions.Methods:During the period between January 2010 and December 2012,120 watt PVP surgery was performed on 160 cases of BPH with IPSS scores more than 16.The primary assessment included the following perioperative parameters:operative time,energy consumption,changes in hemoglobin,changes in serum salt concentration,urinary catheter indwelling time,hospital stay,etc.,and complications during and after the operation.International Prostate Symptom Scoring(IPSS),the maximum urine flow rate test(Q_(max)) and the residual urine volume test(RUV) were conducted preoperatively and postoperatively for the patients.The average followup period was 12-24 months.The causes and the treatments of postoperative adverse reactions were analyzed.Results:There were 59 cases of moderate and 101 cases of severe IPSS score,and the average IPSS score was(26.5 ± 6.8).All the patients were safe in perioperation period,the operative time was 30-147 min,there was no intraoperative Mood transfusion,and postoperative cather indwelling time was 2-5 days.Postoperative IPSS score,QOL score,and Q_(max) were increased significantly,RUV <30 mL.Patients were followed up for 12-24 months.During the follow-up period,32 cases were not satisfied with the remission of lower urinary tract symptoms.Urodynamic studies and urinary tract endoscopy showed bladder outlet obstruction occurred in 25 cases,of which there were 22 cases of prostate gland residue,and 3 cases of bladder neck contracture,and detrusor atony in 6 cases(including 1 case of pseudodysuria),and 1 case of detrusor sphincter dyssynergia(DSD).Conclusions:PVP is an effective way for BPH patients with severe IPSS score.The surgical process is safe and effective,with less bleeding and less postoperative complications.IPSS score can assesst the effect of surgical results.Urodynamic studies can identify the reason of postoperative bad curative effectiveness,assess bladder function and detrusor muscle stability,which provides evidence for differential diagnosis,options of reasonable treatment,and estimation of prognosis.