两种术式治疗较大体积良性前列腺增生的临床比较

Prostate artery embolization vs. transurethral bipolar plasmakinetic prostatectomy in the treatment of large benign prostatic hyperplasia

目的:探讨超选择性前列腺动脉栓塞术(PAE)与经尿道等离子双极前列腺电切术(TUPKP)治疗较大体积前列腺增生所致下尿路症状的疗效及安全性。方法:分析于2016年10月-2017年8月期间接受手术诊疗的144例前列腺体积>80 cm3良性前列腺增生患者,其中42例接受PAE,102例接受TUPKP。比较两组手术前后相关观察指标,以及并发症发生率等情况。结果:与术前比较,术后3、6、12个月两组患者的Qmax均显著增加(P<0.05),PSA、PV、IPSS、QOL、PVR均明显降低(P<0.05);TUPKP组术后3个月各项评价指标明显优于PAE组(P<0.05);术后6、12个月PAE组PV及PSA明显大于TUPKP组(P<0.05);术后6、12个月两组IPSS、QOL、Qmax、PVR组间差异无统计学意义(P>0.05)。TUPKP组有3例(2.9%)在术后病理组织学检查中发现有前列腺癌发生,其中TNM分期为T1a期1例,T1b期2例;随访期间内PAE组内无前列腺癌发生的临床证据。与TUPKP组比较,PAE组手术时间及住院时间均明显缩短(P<0.05)。两组间留置导尿时间差异无统计学意义(P>0.05),PAE组NRS值明显低于TUPKP组(P<0.05);TUPKP组术后并发症发生率明显高于PAE组(P<0.05)。结论:经过有效的术前筛选,PAE可成为针对较大体积良性前列腺增生的有效替代治疗方案。

Objective:To compare the results of superselective prostate artery embolization(PAE)and transurethral plasma bipolar prostatectomy(TUPKP)for giant benign prostatic hyperplasia(BPH).Methods:A retrospective analysis was made on 144 patients with BPH whose prostate volume was more than 80 cm3 from October2016 to August 2017.Among them,42 patients underwent PAE and 102 patients underwent TUPKP.Relevant observation indexes before and after operation,as well as complication rates were analyzed and compared.RESULTS:Compared with the preoperative data,Qmax in PAE group and TUPKP group was significantly increased at 3 rd,6 th and 12 th month after surgery(P<0.05),and PSA,PV,IPSS,QOL and PVR all decreased significantly(P<0.05);The evaluation indexes of TUPKP group were significantly better than those of PAE group at 3 rd month after surgery(P<0.05).PV and PSA in PAE group were significantly higher than those in TUPKP group at 6 th and 12 th month after surgery(P<0.05);There was no significant difference between the two groups in IPSS,QOL,Qmax and PVR at 6 th and 12 th month after surgery(P>0.05).Three cases(2.9%)in TUPKP group were found to have prostate cancer by pathological examination after operation,including 1 case of T1 a stage,and 2 cases of T1 b stage.There was no clinical evidence of prostate cancer in PAE group during the follow-up period.The operation time and hospital stay in PAE group were significantly shorter than those in TUPKP group(P<0.05).There was no significant difference in indwelling time between two groups(P>0.05).The NRS value in PAE group was significantly lower than that in TUPKP group(P<0.05).The incidence of postoperative complications in TUPKP group was significantly higher than that in PAE group(P<0.05).Conclusion:After effectively preoperative screening,PAE can be used as an effective alternative treatment for giant BPH.