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中华腔镜泌尿外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (05) : 572 -578. doi: 10.3877/cma.j.issn.1674-3253.2025.05.005

临床研究

经尿道前列腺热蒸汽消融术在前列腺增生患者中的应用
张子骁1, 乔禹铭1, 钟美浓1,2, 欧阳俊裕1, 何雄龙1, 谢逸钊1, 罗杰珩2, 李厚禾2, 李科1,2,†()   
  1. 1526000　广东，中山大学附属第三医院肇庆医院泌尿外科
    2510630　广州，中山大学附属第三医院泌尿外科
  • 收稿日期:2025-06-30 出版日期:2025-10-01
  • 通信作者: 李科
  • 基金资助:
    国家自然科学基金面上项目(82272896); 中山大学附属第三医院临床研究专项基金(YHJH202406)

Application of transurethral water vapor thermal therapy of the prostate in patients with benign prostatic hyperplasia

Zixiao Zhang1, Yuming Qiao1, Meinong Zhong1,2, Junyu Ouyang1, Xionglong He1, Yizhao Xie1, Jieheng Luo2, Houhe Li2, Ke Li1,2,†()   

  1. 1Department of Urology, Zhaoqing Hospital, the Third Affiliated Hospital of Sun Yat-sen University, Zhaoqing 526000, China
    2Department of Urology, the Affiliated Third Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2025-06-30 Published:2025-10-01
  • Corresponding author: Ke Li
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引用本文：

张子骁, 乔禹铭, 钟美浓, 欧阳俊裕, 何雄龙, 谢逸钊, 罗杰珩, 李厚禾, 李科. 经尿道前列腺热蒸汽消融术在前列腺增生患者中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(05): 572-578.

Zixiao Zhang, Yuming Qiao, Meinong Zhong, Junyu Ouyang, Xionglong He, Yizhao Xie, Jieheng Luo, Houhe Li, Ke Li. Application of transurethral water vapor thermal therapy of the prostate in patients with benign prostatic hyperplasia[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(05): 572-578.

目的

探讨局部浸润麻醉下经尿道前列腺热蒸汽消融术对于不同程度前列腺增生患者的安全性以及治疗效果。

方法

回顾性分析2023年6月至2024年6月在中山大学附属第三医院肇庆医院完成经尿道前列腺热蒸汽手术的96例患者，根据术前前列腺体积分为<80 mL组和≥80 mL组，收集围手术期相关指标，评估术后临床疗效、术后不良反应及并发症情况。

结果

所有患者均在局部浸润麻醉下完成手术，平均消融针数为（7.03±2.88）针。两组患者术后的国际前列腺症状评分（IPSS）、最大尿流率（Qmax）、生活质量（QOL）及残余尿量（PVR）均呈持续改善趋势（P<0.001）。同时，对于术前保持性生活的患者，IIEF-5评分在两组均无显著变化（P>0.05），≥80 mL组术后1个月出现短暂下降（P=0.042）。热蒸汽消融术后主要并发症包括尿路感染（19.8%）、尿潴留（17.7%）、尿频尿急（15.6%）等，且多为Clavien-Dindo Ⅰ/Ⅱ级，两组间术后并发症发生率差异均无统计学意义（均P>0.05）。

结论

经尿道前列腺热蒸汽消融术作为一种前列腺增生超微创治疗方法，能够显著改善患者排尿功能，保护性功能，且对于重度前列腺增生患者同样安全有效。

关键词: 前列腺增生, 热蒸汽消融术, 下尿路症状, 局部麻醉, 微创治疗
Objective

To investigate the safety and therapeutic efficacy of transurethral water vapor thermal therapy under local anesthesia in patients with different degrees of benign prostatic hyperplasia (BPH).

Methods

A retrospective analysis was conducted on 96 patients who underwent transurethral water vapor thermal therapy from June 2023 to June 2024. Patients were divided into two groups based on preoperative prostate volume: <80 mL group and ≥80 mL group. Data of perioperative clinical characteristics were collected, and postoperative efficacy, adverse events, and complications were evaluated.

Results

All patients successfully underwent the procedure under local infiltration anesthesia, with an average of (7.03±2.88) needle insertions performed. Postoperative international prostate symptom score (IPSS), maximum urinary flow rate (Qmax), quality of life (QOL), and post-void residual (PVR) in both groups showed a continuous improvement trend (all P<0.001). Moreover, in patients who maintained sexual activity preoperatively, the International Index of Erectile Function-5 (IIEF-5) scores showed no significant differences in both groups (P>0.05), with only the ≥80 mL group demonstrating a transient decline at 1 month postoperatively (P=0.042). The main postoperative complications included urinary tract infection (19.8%), urinary retention (17.7%), urinary frequency and urgency (15.6%), most of which were classified as Clavien-Dindo grade I/II, and there were no significant differences in postoperative complication rates between the two groups (all P>0.05).

Conclusion

Transurethral water vapor thermal therapy which serves as an ultra-minimally invasive treatment for BPH, can significantly improve urinary function and preserve sexual function. It is equally safe and effective for patients with large prostate volumes.

Key words: Benign prostatic hyperplasia, Water vapor thermal therapy, Lower urinary tract symptoms, Local anesthesia, Minimally invasive procedures
表1 行经尿道前列腺热蒸汽消融术BPH患者术前基本资料（±s）
组别 例数 年龄（岁） IPSS（分） QOL（分） Qmax（mL/s） PVR （mL) 前列腺体积（mL）
前列腺体积<80 mL组 68 68.28±8.72 21.57±5.03 4.82±0.95 9.22±3.13 75.84±54.95 49.97±15.81
前列腺体积≥80 mL组 28 71.71±6.72 23.36±6.38 4.96±0.74 9.46±4.39 69.71±43.56 103.50±20.79
t值   -1.867 -1.457 -0.702 -0.306 0.525 -13.712
P值   0.065 0.148 0.484 0.760 0.601 <0.001
图1 行经尿道热蒸汽消融术BPH患者围术期各项指标的变化
表2 行经尿道前列腺热蒸气消融BPH患者术后随访指标（±s）
  前列腺体积<80 mL（n=68） 前列腺体积≥80 mL（n=28）
观察指标 术后1个月 术后3个月 术后6个月 术后1个月 术后3个月 术后6个月
IPSS(分)            
术前 21.57±5.03 21.57±5.03 21.57±5.03 23.36±6.38 23.36±6.38 23.36±6.38
术后 14.41±5.59 8.56±4.15 7.37±3.75 16.11±4.84 11.11±4.60 10.07±4.46
t值 -9.978 -18.897 -19.037 -6.677 -11.295 -12.165
P值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
Qmax(mL/s)            
术前 9.22±3.13 9.22±3.13 9.22±3.13 9.46±4.39 9.46±4.39 9.46±4.39
术后 12.18±3.16 15.29±2.95 16.21±3.43 11.86±4.71 15.39±3.85 16.57±2.97
t值 8.455 15.950 14.327 12.286 19.503 16.965
P值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
QOL(分)            
术前 4.82±0.95 4.82±0.95 4.82±0.95 4.96±0.74 4.96±0.74 4.96±0.74
术后 2.87±1.02 1.68±0.85 1.51±0.86 3.04±1.04 2.00±0.77 1.86±0.76
t值 -14.681 -26.443 -27.806 -10.047 -18.716 -22.299
P值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
PVR(mL)            
术前 75.84±54.95 75.84±54.95 75.84±54.95 69.71±43.56 69.71±43.56 69.71±43.56
术后 53.76±40.37 39.59±29.14 36.74±23.75 52.00±33.09 35.14±21.23 35.75±18.03
t值 -5.153 -7.778 -7.697 -3.442 -5.680 -5.261
P值 <0.001 <0.001 <0.001 0.002 <0.001 <0.001
IIEF-5(分) 前列腺体积<80 mL术前保持性生活(n=37) 前列腺体积≥80 mL术前保持性生活(n=12)
术前 15.92±5.31 15.92±5.31 15.92±5.31 15.17±5.83 15.17±5.83 15.17±5.83
术后 15.95±5.33 15.59±5.18 15.86±5.76 14.25±5.59 14.92±6.43 15.00±6.35
t值 0.086 -1.015 -0.157 -2.303 -0.464 -0.297
P值 0.932 0.317 0.876 0.042 0.651 0.772
图2 BPH患者前列腺体积变化与热蒸汽消融针数之间的关系
图3 前列腺热蒸汽消融治疗BPH安全性评估
表3 不同前列腺体积BPH患者行经尿道前列腺热蒸汽消融并发症比较[例(%)]
组别 例数 尿路感染 尿潴留 尿频尿急 排尿困难 肉眼血尿
体积<80 mL组 68 13 (19.1) 14 (20.6) 12 (17.6) 6 (8.8) 7 (10.3)
体积≥80 mL组 28 6 (21.4) 3 (10.7) 3 (10.7) 5 (17.9) 4 (14.3)
χ2值   0.067 0.736 0.293 0.829 0.042
P值   0.796 0.391 0.588 0.363 0.837
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