目的 探讨前列腺体积＞60 mL的前列腺增生症患者的手术安全性，提高部分合并尿道狭窄前列腺增生症患者的手术实施率。 方法 2009年3月－2010年3月，行耻骨上膀胱穿刺引流下经尿道前列腺电切术（TURP）治疗前列腺增生58例。年龄54～93岁，平均72岁，病程8个月～12年，平均7.2年；前列腺体积35～128 mL，平均78 mL；国际前列腺症状评分24～35分，平均30.2分 ；最大尿流率1.2～4.8 mL/s，平均1.8 mL/s；残余尿量84～210 mL，平均160 mL。术前无尿潴留28例。 结果 58例顺利完成手术，其中2例伴包膜穿孔，9例前尿道狭窄者通过去外鞘电切镜完成手术。所有患者切除前列腺组织体积18～86 mL，平均58 mL；术中冲洗液为5%葡萄糖液，用量18 600～42 500 mL，平均23 500 mL；手术时间45～185 min，平均70 min。术后病理检查均示良性前列腺增生，术后住院时间3～8 d，平均5 d。术后患者最大尿流率为18～46 mL/s，平均32 mL/s。 结论 耻骨上膀胱穿刺引流能降低膀胱内压，减少水、糖分吸收，增加手术安全性，提高了部分合并前尿道狭窄的前列腺增生患者的手术几率。
目的:探讨基层医院前列腺增生并膀胱结石的微创治疗方法。方法:联合经尿道等离子双极电切与耻骨上小切口治41例前列腺增生症并膀胱结石。结果:手术时间40~110min, 平均55min,术后3d拔造瘘管, 第5~6天拔除尿管,排尿通畅, 无电切综合征(TURS)、大出血等并发症,住院时间7±1.5天。数字疼痛评分0~6,平均3.5。结论：等离子体双极电切结合耻骨上小切口是治疗前列腺增生并膀胱结石的一种快速、安全有效、微创的手术方法,值得在基层医院推广。
Objective To evaluate the correlation between hyperuricemia (HUA) and benign prostatic hyperplasia (BPH). Methods A total of 666 elderly male patients, who had been admitted to the West China Hospital for routine physical examination in May, 2010, were included in this study. All the following indexes were collected: blood pressure, waistline, medical history, international prostatic symptom score (IPSS), serum uric acid (UA), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG-2), prostate-specific antigen (PSA), and prostate volume (PV) measured by ultrasound. Patients with higher level of UA more than 420 μmol/L were included into the HUA group (n=151) while the other patients with normal UA (NUA) were in the NUA group (n=515). Both the metabolic and prostate related indexes in the two groups were compared, and the correlation between HUA and each indexes were analyzed using logistic regression model. Results HUA was significantly associated with abdominal obesity (OR=1.575, 95%CI 1.059 to 2.340), hypertriglyceridemia (OR=2.78, 95%CI 1.877 to 4.118), metabolic syndrome (CDS2007) (OR=1.912, 95%CI 1.267 to 2.885), BPH (OR=1.464, 95%CI 1.465 to 1.635) and lower urinary tract symptoms (LUTS) rating (OR=1.782, 95%CI 1.173 to 1.522). Conclusion HUA is correlated with BPH, meanwhile it is highly accompanied with other risk factors of cardioascular diseases. Hereby, comprehensive medical screening should be considered when treating such patients.
Objective To access the efficacy and safety of Holmium laser prostatectomy technique compared to TURP. Methods We searched MEDLINE (1996 to 2004), EMBASE (1984 to 2004), The Cochrane Library (Issue 4, 2004), CNKI, VIP, CMCC and CBMdisc; and handsearched the relevant Chinese journals. Randomized controlled trials (RCT) were included. The quality of trials was evaluated and meta-analysis was performed. Non-randomized controlled trials were also included to evaluate the safety and efficacy. Results We found 4 randomized controlled trials. A total of 480 participants were in the trials ranging from 60 to 200. There was no statistical difference between the two techniques at 12 or 48 months follow-up in terms of quality of life (QOL) improvement（WMD=-0.19, 95%CI -0.81 to 0.44, Z=0.59, P=0.56; WMD=-0.30, 95%CI -0.90 to 0.30, Z=0.98, P=0.33); Qmax improvement（WMD=1.63 ml/s, 95%CI -0.32 to 3.59, Z=1.64, P=0.10; WMD=3.80 ml/s, 95%CI -1.36 to 8.96,Z=1.44, P=0.15); I-PSS or AUA (WMD=-0.06, 95%CI -1.01 to 0.89, Z=0.12, P=0.91; WMD=-1.40, 95%CI -3.91 to 1.11, Z=1.09, P=0.27) and the urethral stricture complication rate (RR=0.75, 95%CI 0.35 to 1.60, Z=0.74, P=0.46). However hospital stay was significantly shorter in the Holmium laser prostatectomy groups (total WMD=-24.89, 95%CI -28.56 to -21.21, Z=13.27, P＜0.000 01). We can not draw consistent conclusions in terms of blood loss according to the present data. One study indicated Holmium laser prostatectomy technique was more cost-effective than TURP. Conclusions In short period Holmium laser prostatectomy is as safe as TURP in terms of hospital stay, urethral stricture and blood loss complication. This new technique is as effiective as TURP in terms of I-PSS (AUA), Qmax and QOL. More RCTs and more long term follow-up is necessary.
Objective To evaluate the correlation between benign prostatic hyperplasia (BPH) and metabolic syndrome (MS). Methods Total 666 elderly male patients admitted to West China Hospital for routine physical examination in May, 2010 were included in this study. The related laboratory tests of BPH and MS were taken. The correlation among BPH, lower urinary tract Symptoms (LUTS), prostate volume (PV), MS and its component diseases were analyzed. Results Hypertension was an important risk factor for BPH (OR=1.309, 95%CI 1.033 to 1.661), low HDL-C hyperlipidemia was a risk factor for IPSS scored over 7 points (OR=1.573, 95%CI 0.330 to 0.997), and the score of PV was positively correlated to obesity, hypertension, low HDL-C hyperlipidemia and MS (all Plt;0.05). Conclusion For the patient with BPH, MS and its component diseases mainly exert their effects on PV changes rather than LUTS.
摘要:目的:探讨经尿道前列腺等离子切除术(PKRP)治疗前列腺增生症(BPH)的疗效及安全性。方法:回顾分析采用PKRP治疗的BPH患者,收集患者临床资料,随访12个月,并对手术前后患者国际前列腺症状评分、最大尿流率、生活质量评分进行比较。结果:2006年8月至2008年8月PKRP手术治疗BPH患者共238例,手术时间30～159 min,平均70 min,切除腺体25～127 g,平均54 g。无电切综合征。术后及1年后最大尿流率、国际前列腺症状评分、生活质量评分三项指标较术前明显改善(Plt;0.05)。结论:PKRP是治疗BPH安全有效的治疗方式。Abstract: Objective: To assess the clinical efficacy and safety of plasmakinetic energy transurethral resection of the prostate (PKRP) for benign prostatic hypertrophy (BPH). Methods: The data of patients with BPH treated with PKRP were retrospectively analyzed and the International Prostate Symptoms Scales (IPSS), maximum flow rate (Qmax) and Quality of Life (QOL) of patients with 12month followup were compared before and afteroperation and postoperation. Results: A total of 238 patients with BPH were enrolled from June 2006 to June 2008. The duration of the procedure was 70. 3 min (ranged from 30 min to 159 min) and the weight of dissected tissue was 54 g (ranged from 25 g to 127 g). No transurethral resection syndrome occurred. IPSS, Qmax and QOL were improved obviously after operation (Plt;0.05). Conclusion: PKRP is effective and safe.
目的:探讨微创治疗BPH并发膀胱结石的方法。方法:应用气压弹道碎石术联合TURP治疗BPH并发膀胱结石26例。结果:24例一次成功,1例一期碎石,二期行TURP;1例中转开放手术。结论:气压弹道碎石术联合TURP治疗BPH并发膀胱结石创伤小,恢复快,安全高效。