超选择性前列腺动脉栓塞术治疗超大体积前列腺增生的疗效分析

doi:10.3877/cma.j.issn.1674-3253.2021.05.005

中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 383 -387. doi: 10.3877/cma.j.issn.1674-3253.2021.05.005

临床研究

超选择性前列腺动脉栓塞术治疗超大体积前列腺增生的疗效分析

郐海洋¹, 马志方²^,^†(

), 冯对平³, 余立冲², 杭天昆¹, 石明凯¹

^1. 030001　太原，山西医科大学第一临床医学院
^2. 山西医科大学第一医院泌尿外科
^3. 山西医科大学第一医院介入科

收稿日期:2020-11-06 出版日期:2021-10-01
通信作者: 马志方

Effect of super-selective prostatic artery emboliation in the treatment of ultra-large benign prostate hyperplasia

Haiyang Kuai¹, Zhifang Ma²^,^†(), Duiping Feng³, Lichong Yu², Tiankun Hang¹, Mingkai Shi¹

^1. The First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China
^2. Department of Urology, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
^3. Department of Intervention, the First Hospital of Shanxi Medical University, Taiyuan 030001, China

Received:2020-11-06 Published:2021-10-01
Corresponding author: Zhifang Ma

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目的

探讨超选择性前列腺动脉栓塞术（PAE）治疗超大体积（≥120 ml）前列腺增生的安全性及临床疗效。

方法

回顾性分析2018年8月至2019年12月于山西医科大学第一医院采用超选择性前列腺动脉栓塞术治疗的18例超大体积前列腺增生患者的临床资料，比较术前与术后1、3、6个月患者的前列腺体积（PV）、前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Q_max）及残余尿量（RUV）等各项指标的差异并观察手术的并发症。

结果

18例前列腺增生患者行PAE的手术时间为95~190 min，中位手术时间130 min。术后4例出现轻微的耻骨区疼痛和尿道烧灼感，2例出现一过性血尿，3例患者出现发热症状，12例患者于术后第3天成功拔除尿管，拔除尿管后均可自行排尿，其余6例患者拔除尿管时间为术后10~21 d，所有患者术后均未出现严重的并发症。术后1、3、6个月随访时患者的PV、IPSS、QOL、RUV较术前明显降低，Q_max较术前明显增高，差异有统计学意义（P<0.05）。

结论

PAE治疗超大体积前列腺增生安全、有效，在临床上PAE可作为一种治疗超大体积前列腺增生的手术方式。

关键词: 超选择性，前列腺动脉栓塞术, 大体积，前列腺增生, 尿动力分析

Objective

To explore the safty and efficacy of super-selective prostatic artery embolization (PAE) in the treatment of ultra-large (≥120 ml) benign prostate hyperplasia.

Methods

The clinical data of 18 patients with ultra-large benign prostate hyperplasia treated with PAE in the First Hospital of Shanxi Medical University from August 2018 to December 2019 were analyzed retrospectively. The prostate volume (PV),international prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Q_max) and residual urine volume (RUV) were compared before and 1, 3, and 6 months after surgery, and the operation complications were observed.

Results

The operation time of PAE in 18 patients with benign prostatic hyperplasia was 95-190 min, and the median operation time was 130 min. After the operation, 4 cases developed mild pubic pain and urethral burning, 2 cases developed transient hematuria, and 3 cases developed fever. 12 patients were successfully removed the urinary catheter on the third day after surgery. After the urinary catheter was removed, they could urinate spontaneously. The remaining 6 patients had the urinary catheter removed from 10 to 21 days after surgery. No serious complications occurred in all patients. The patients' PV, IPSS, QOL and RUV were significantly lower than those before surgery at 1, 3, and 6 months after surgery, and Q_max was significantly higher than before surgery, the difference was statistically significant (P<0.05).

Conclusion

PAE is safe and effective in treating ultra-large benign prostate hyperplasia. And PAE can be used as a surgical method for the treatment of ultra-large benign prostate hyperplasia in clinic.

Key words: Super-selective, prostatic artery embolization, Large volume, benign prostate hyperplasia, Uroclynamics

图1 一例79岁男性BPH患者术前术后影像学资料注：a为术中超选择性前列腺动脉造影可见前列腺区域染色浓密，前列腺内部血管迂曲紊乱；b为栓塞后再次造影可见前列腺区域染色消失，前列腺动脉近端呈铸型；c、d、e、f为术后3个月复查前列腺核磁可见前列腺实质内多发局部缺血坏死灶（箭头处），前列腺体积较术前明显缩小，患者排尿困难症状较术前明显改善

表1 17例超大前列腺体积BPH患者行PAE术前及术后各时间点各项临床观察指标的比较（±s）

	PV(ml)	IPSS(分)	QOL(分)	Q_max(ml/s)	RUV(ml)
术前	168.12±35.250	29.88±2.39⁰	5.29±0.69⁰	⁰6.20±0.90	136.18±42.010⁰
术后1个月	121.29±29.19^a	11.24±1.60^a	2.94±0.75^a	11.46±1.01^a	75.29±29.02^a
术后3个月	097.24±17.96^b	07.12±1.27^b	2.11±0.60^b	13.95±0.99^b	48.24±24.87^b
术后6个月	090.76±14.53^c	06.53±1.23^c	1.88±0.60^c	15.16±1.14^c	33.82±18.84^c
F值	147.16	1284.30	188.00	317.17	104.65
P值	<0.001	<0.001	<0.001	<0.001	<0.001

表1 17例超大前列腺体积BPH患者行PAE术前及术后各时间点各项临床观察指标的比较（±s）

	PV(ml)	IPSS(分)	QOL(分)	Q_max(ml/s)	RUV(ml)
术前	168.12±35.250	29.88±2.39⁰	5.29±0.69⁰	⁰6.20±0.90	136.18±42.010⁰
术后1个月	121.29±29.19^a	11.24±1.60^a	2.94±0.75^a	11.46±1.01^a	75.29±29.02^a
术后3个月	097.24±17.96^b	07.12±1.27^b	2.11±0.60^b	13.95±0.99^b	48.24±24.87^b
术后6个月	090.76±14.53^c	06.53±1.23^c	1.88±0.60^c	15.16±1.14^c	33.82±18.84^c
F值	147.16	1284.30	188.00	317.17	104.65
P值	<0.001	<0.001	<0.001	<0.001	<0.001

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