摘要
为探讨合并膀胱逼尿肌无力(detrusor underactivity,DU)的前列腺增生患者进行激光治疗的安全性及临床疗效。通过分析2017年1月—2019年11月完成的10例激光治疗的合并DU的前列腺增生患者资料:年龄58~88岁(平均74.00岁),其中长期留置尿管引流尿液1例,前列腺超声测得体积24.1~94.26 mL(平均46.7 mL)。术前泌尿系彩超、直肠指诊、膀胱镜检查及尿动力检查明确前列腺增生诊断。尿动力学检查结果显示:最大逼尿肌压力(P_(det,max))为15~49.5 cm H_(2)O(平均35.3 cm H_(2)O),膀胱收缩指数(bladder contractility index,BCI)为21~89,线性被动尿道阻力关系分级(linearized passive urethral resistance relation,linPURR)3例膀胱出口梗阻(bladder outlet obstruction,BOO),6例可疑膀胱出口梗阻,1例无膀胱出口梗阻,排除前列腺癌。观察术中出血情况、手术时间、并发症发生情况。观察术前术后国际前列腺症状评分(international prostate symptom score,IPSS)、生活质量评分(qaulity of life,QoL)、最大尿流率(maximum urinary flow rate,Q_(max))及术后尿管留置时间。观察及随访术后排尿情况,有无尿潴留及再次置管并发症。结果表明:10例手术过程顺利,未发现严重脑梗、心梗、血栓、大量出血及周围器官组织损伤等严重并发症。手术时间40~130 min(平均70 min)。术后留置导尿管时间4~12 d(平均5.4 d)。术后Q_(max)由术前(4.4±0.6)mL/s增加至(13.9±5.7)mL/s(P<0.05),IPSS及QoL分别从(21.3±6.2)分和(5.1±1.1)分降到(10.8±4.1)分和(1.4±0.7)分,手术前后比较差异均有统计学意义(P<0.05)。术后拔尿管后能自行排尿,随访3~6月无尿潴留及尿失禁发生。可见合并DU的前列腺增生患者并非手术治疗的绝对禁忌症,经尿道激光前列腺切除术治疗该类患者是一种安全、有效的微创治疗方法。
To investigate the safety and clinical efficacy of laser therapy in patients with benign prostatic hyperplasia complicated with bladder detrusor weakness(detrusor underactivity,DU).Ten patients benign prostatic hyperplasia complicated with DU were included in our department from January 2017 to November 2019.All patients were treated with laser,aged from 58 to 88 years old(mean 74.00 years old).Among them,1 case was drained by indwelling catheter for a long time,and the volume of prostate measured by ultrasound was 24.1~94.26 mL(mean 46.7 mL).Before operation,urologic color doppler ultrasound,rectal digital examination,cystoscopy and urodynamic examination were used to confirm the diagnosis of benign prostatic hyperplasia.Urodynamic results show that the maximum detrusor pressure(P_(det,max))is 15~49.5 cm H_(2)O(mean 35.3 cm H_(2)O).Bladder contractile index(BCI)is 21~89.The linearized passive urethral resistance(linPURR)shows 3 cases of bladder outlet obstruction,6 cases of suspected bladder outlet obstruction and 1 case of no bladder outlet obstruction,All patients are excluded from prostate cancer.The prostate bleeding,operation time,postoperative indwelling time of urinary catheter and postoperative complications were observed and recorded.The following data were recorded before and after operation,including international prostate symptom score(IPSS),quality of life score(QoL),maximum urine flow rate(Q_(max))and indwelling time of urinary catheter after operation.The postoperative urination,urinary retention and complications of re-catheterization were obtained during the follow-up.The results show that the operations of all the 10 patients are carried out successfully,and no serious complications such as severe cerebral infarction,myocardial infarction,thrombus,massive hemorrhage and injury of surrounding organs and tissues are found.The operation time is 40~130 min(mean 70 min).The time of indwelling catheter is 4~12 d(mean 5.4 d).Postoperative Qmax increases from preoperative(4.4±0.6)mL/s to(13.9±5.7)mL/
作者
郭光
刘萃龙
王希友
GUO Guang;LIU Cui-long;WANG Xi-you(Naval Clinical College, Anhui Medical University, Beijing 100048, China;Department of Urology, The Sixth Medical Center of PLA General Hospital, Beijing 100048, China)
出处
《科学技术与工程》
北大核心
2021年第16期6632-6636,共5页
Science Technology and Engineering
基金
北京市科学技术委员会首都临床特色应用研究专项(Z171100001017174)。
关键词
激光治疗
前列腺增生
逼尿肌无力
临床效果
laser therapy
benign prostatic hyperplasia
detrusor underactivity
clinical observation
