经尿道前列腺电切术后再增生临床病理分析

发布时间：2018-03-04 10:32

本文选题：前列腺增生　切入点：复发　出处：《福建中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的统计复发性前列腺增生患者因严重血尿入院的比例;比较初次增生与再次增生的前列腺在腔镜下的形态差异;比较初次增生与再次增生前列腺病理组织学成分的差异,探讨复发性前列腺增生患者血尿多发的临床病理基础。方法回顾性分析厦门大学附属中山医院2008年01月至2017年01月期间收治的801例前列腺增生患者及57例复发性前列腺增生患者的临床资料,比较二者因严重血尿入院比例之间的差异。腔镜下观察并比较二者前列腺大体形态上的差异。选取前后两次均在我院行经尿道前列腺电切术的19例复发性前列腺增生患者,免疫组化检测两次增生的前列腺组织内PSA、CD34及SMA的表达,用计算机图像分析系统计算前列腺上皮、腺管腔及平滑肌相对含量及微血管密度,统计分析两次增生的前列腺组织各成分相对含量间的差异。结果801例前列腺增生患者因严重血尿而入院者18例,约占2.2%;57例复发性前列腺增生患者以严重血尿为主诉入院者26例,约占45.6%,是其入院第一位的原因;二者主诉占比之间的差异有统计学意义(P0.05)。在电切镜下观察,初次增生的前列腺组织两侧叶呈均匀一致的增生,表面光滑;再次增生的前列腺组织两侧叶均呈不规则结节样增生,表面粗糙,粘膜有时可见明显的出血点。免疫组化结合图像分析测得19例复发性前列腺增生患者初次增生组前列腺上皮、腺管腔及平滑肌平均占比分别为18.4±13.2%、9.3±3.5%、35.7±15.2%;而再次增生组前列腺上皮、腺管腔及平滑肌平均占比分别为16.4±8.5%、8.6±3.3%、29.7±12.2%。初次增生组、再次增生组的前列腺微血管密度均值分别为22.9±9.1、27.5±9.3。再次增生组的前列腺平滑肌相对含量低于初次增生组,两组差别有统计学意义(P0.05);微血管密度均值高于初次增生组,两组差别有统计学意义(P0.05);两组间上皮及腺管腔占比的差异无统计学意义(P0.05)。结论复发性前列腺增生患者主要因严重血尿而入院,约占45.6%,其前列腺大体形态表现多呈不规则结节样增生,表面易出血。前列腺组织内微血管密度的增高、薄壁血管的增多以及平滑肌欠发达、结构紊乱、相对含量减少等特点可能是引起复发性前列腺增生血尿多发的原因。
[Abstract]:Objective to analyze the proportion of patients with recurrent prostatic hyperplasia admitted to hospital due to severe hematuria, to compare the morphological differences between primary hyperplasia and rehyperplastic prostate under endoscopy, and to compare the differences of histopathological components between primary hyperplasia and rehyperplasia of prostate. To investigate the clinicopathological basis of hematuria in patients with recurrent prostatic hyperplasia. Methods 801 patients with benign prostatic hyperplasia and 57 patients with recurrent prostatic hyperplasia admitted from January 2008 to January 2017 in Zhongshan Hospital affiliated to Xiamen University were analyzed retrospectively. Clinical data of patients with prostatic hyperplasia, To compare the difference of admission ratio between the two patients due to severe hematuria, to observe and compare the difference in gross morphology of prostate under endoscopy, and to select 19 patients with recurrent prostatic hyperplasia who underwent transurethral resection of prostate in our hospital before and after operation. The expression of PSA-CD34 and SMA in the prostatic tissues with double hyperplasia was detected by immunohistochemistry. The relative contents of prostatic epithelium, glandular lumen and smooth muscle and microvessel density were calculated by computer image analysis system. Results among 801 patients with benign prostatic hyperplasia, 18 patients were admitted to hospital because of severe hematuria, accounting for about 2.2% 57 patients with recurrent prostatic hyperplasia, 26 patients were admitted with severe hematuria as the main complaint. About 45.6% was the first reason of admission, and the difference between the two main complaints was statistically significant (P 0.05). The primary hyperplasia of prostatic tissue was homogeneous and uniform, and the surface was smooth. There were irregular nodular hyperplasia on both sides of the prostatic tissue with rough surface and obvious bleeding spots in the mucous membrane. The prostatic epithelium of 19 patients with primary hyperplasia of recurrent prostatic hyperplasia was detected by immunohistochemistry combined with image analysis. The average ratio of glandular lumen and smooth muscle was 18.4 卤13.2and 9.3 卤3.5and 35.7 卤15.2respectively, while that of prostatic epithelium, glandular lumen and smooth muscle in hyperplastic group was 16.4 卤8.5and 8.6 卤3.3 卤29.7 卤12.2.The mean ratio of prostatic epithelium and smooth muscle in primary hyperplasia group was 29.7 卤12.2. The mean value of microvessel density of prostate in rehyperplasia group was 22.9 卤9.1 卤9.3.The relative content of prostatic smooth muscle in rehyperplasia group was lower than that in primary hyperplasia group, and the difference between the two groups was statistically significant (P 0.05), and the mean microvessel density was higher than that in primary hyperplasia group. There was no significant difference between the two groups in the proportion of epithelium and glandular lumen between the two groups. Conclusion the patients with recurrent prostatic hyperplasia are mainly admitted to hospital because of severe hematuria. About 45.6% of the prostate showed irregular nodular hyperplasia and haemorrhage on the surface. The increase of microvessel density in prostate tissue, the increase of parenchyma vessels, the underdevelopment of smooth muscle and the disorder of structure. The decrease of relative content may be the cause of recurrent prostatic hyperplasia hematuria.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.8

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