不同手术时机治疗小体积BPH的临床对比研究

发布时间：2018-04-10 02:40

  本文选题：小体积良性前列腺增生症　切入点：手术时机　出处：《延安大学》2014年硕士论文

【摘要】：【目的】 通过比较不同手术时机小体积良性前列腺增生症（BPH）患者的住院日、住院费用和术后国际前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（Qmax）、残余尿（PVR）、夜尿次数及B超观察膀胱壁形态变化，探讨小体积BPH患者的最佳手术时机，以减少这部分BPH患者的并发症，保护肾功能，最大程度的提高这部分患者的生活质量及减少其远期医疗费用。 【方法】 采用前瞻性对照研究，选取2011年12月—2013年4月期间在延安大学附属医院泌尿外科就诊确诊为小体积BPH的患者136例，平均年龄（65.1±5.4）岁，，B超提示其膀胱壁均出现增厚、毛糙改变。根据术前IPSS评分及PVR分组，患者IPSS小于20且PVR小于50ml时选择手术治疗的入选A组，病例30人，平均年龄（62.1±5.2）岁；患者IPSS大于20或PVR大于50ml选择手术治疗的入选B组，病例30人，平均年龄（63.9±5.7）岁；患者IPSS大于20同时PVR大于50ml选择手术治疗的入选C组，病例30人，平均年龄（67.4±5.8）岁。三组病例均采用TURP+TURBN术进行治疗。比较三组病例的住院日、住院费用，并对三组病例分别在术后3个月、6个月、12个月进行随访观察，比较其术后IPSS、QOL、Qmax、PVR及夜尿次数，B超观察其膀胱壁的变化。 【结果】 三组病例的住院日：A组（6.2±1.3天）小于B组（7.7±1.7天），B组小于C组（10.1±1.9天）（P0.01）。住院费用：A组（6697.3±210.6元）小于B组（7219.3±287.6元），B组小于C组（8272.0±672.2元）（P0.01）。 术后3个月时，A组的IPSS [8.0(7.0~9.0)]分、QOL [3.0(2.0~4.0)]分、Qmax[11.0(10.0~12.0)]ml/s、PVR [30.0(29.0~33.3)]ml和夜尿次数[5.0(4.0~7.0)]次与B组本研究得到延安市2012年科技计划项目（编号：2012KW-15）资助。[IPSS9.0(8.0~11.0)分、 QOL3.0(3.0~4.0)分、 Qmax10.0(9.0~11.0)ml/s、 PVR34.5(28.8~36.3)ml、夜尿次数6.0(5.0~8.0)次]比较均无统计学意义（P0.0167）。A组与C组[IPSS18.0(16.8~21.0)分、QOL4.0(4.0~5.0)分、Qmax7.0(6.0~7.0)ml/s、PVR45.5(38.0~57.8)ml、夜尿次数7.5(6.0~9.3)次]比较各指标均有统计学意义（P0.0167）。B组和C比较各指标均有统计学意义（P0.0167）。B超观察膀胱壁显示：三组病例膀胱壁均增厚、毛糙。 术后6个月时，A组的IPSS[7.0(5.0~9.0)]分、QOL[3.0(2.0~3.0)]分与B组[IPSS8.0(7.0~9.0)分、 QOL3.0(2.0~4.0)分]比较无统计学意义（P0.0167）。 A组的Qmax[14.0(11.8~16.0)]ml/s、PVR[25.0(21.0~29.0)]ml和夜尿次数[4.0(3.0~5.3)]次优于B组[Qmax12.0(10.0~13.0)ml/s、PVR28.0(23.0~35.3)ml、夜尿次数5.5(4.0~7.0)次]（P0.0167）。B组各指标均优于C组[IPSS15.5(13.0~18.0)分、QOL4.0(3.0~5.0)分、Qmax9.0(7.0~11.0)ml/s、PVR34.5(27.5~46.3)、夜尿次数7.0(6.0~8.0)次]（P0.0167）。A组各指标也均优于C组（P0.0167）。A组膀胱壁厚；B组膀胱壁增厚、毛糙；C组膀胱壁增厚、毛糙。 术后12个月时，A组的IPSS [4.0(3.0~5.0)]分、QOL [1.5(1.0~2.0)]分、Qmax[18.0(16.0~20.0)]ml/s、PVR [14.0(10.0~16.0)]ml和夜尿次数[1.0(1.0~2.0)]次均优于B组[IPSS8.0(7.0~9.0)分、 QOL3.0(2.0~3.0)分、 Qmax14.0(13.0~16.0)ml/s、 PVR18.0(15.0~21.0)ml、夜尿次数3.0(2.0~4.0)次]（P0.0167）。B组各指标均优于C组[IPSS13.0(11.8~16.0)分、 QOL4.0(3.0~4.0)分、 Qmax10.0(8.0~12.3)ml/s、PVR25.0(20.0~28.0))ml、夜尿次数4.0(3.0~5.3)次]（P0.0167）。B超观察膀胱壁显示：A组膀胱壁普遍较光滑，无增厚、毛糙；B组膀胱壁厚；C组膀胱壁较厚、毛糙。 【结论】 1.长期随访显示在IPSS小于20分且残余尿量小于50ml，但B超显示膀胱壁已发生改变的小体积BPH患者，早期手术术后生活质量最好。 2.在出现膀胱壁形态改变初期时选择手术可能是治疗小体积BPH的最佳手术时机。 3.膀胱壁形态改变可能作为判断小体积BPH手术时机的指征普遍应用于临床。
[Abstract]:[Objective]
By comparing the different timing of surgery of small volume benign prostatic hyperplasia (BPH) patients in hospitalization, hospitalization expenses and postoperative International Prostate Symptom Score (IPSS), quality of life score (QOL), maximum urinary flow rate (Qmax), residual urine (PVR), nocturia and ultrasound to observe the morphological changes of the bladder wall. To explore the optimal time for operation of small volume in patients with BPH, in order to reduce the complications in BPH patients, protect renal function, improve the maximum level of this part of the quality of life of patients and reduce the long-term medical expenses.
[method]
A prospective case-control study from December 2011 to April 2013 during the Department of Urology in Affiliated Hospital of Yan'an University diagnosed 136 cases of BPH patients with small volume, average age (65.1 + 5.4) years old, b-tip the bladder wall were thickening, rough change. According to the preoperative IPSS score and PVR group, patients with IPSS less than 20 PVR and less than 50ml selection of surgical treatment in A group, 30 cases, the average age (62.1 + 5.2); patients with IPSS greater than 20 or greater than 50ml PVR selection B group of surgical treatment, 30 cases, the average age (63.9 + 5.7); patients with IPSS greater than 20 and PVR more than 50ml selection group C surgery in the case of 30 people, average age (67.4 + 5.8) years old. Three groups were treated with TURP+TURBN therapy. The three groups were compared the hospitalization days, hospitalization expenses, and three cases were in postoperative 3 months, 6 months, 12 months after the view The changes of IPSS, QOL, Qmax, PVR and nocturia after operation were compared and the bladder wall of the bladder was observed by B ultrasound.
[results]
The hospitalization days of the three groups were: A group (6.2 + 1.3 days) less than B group (7.7 + 1.7 days), group B was less than C group (10.1 + 1.9 days) (P0.01). Hospitalization expenses: A group (6697.3 + 210.6 yuan) was less than B group (7219.3 7219.3 yuan), B group was less than C group (287.6 + 287.6 yuan) (P0.01).
3 months after operation, A group, IPSS [8.0 (7.0~9.0)], QOL [3.0 (2.0~4.0)], Qmax[11.0 (10.0~12.0]ml/s), PVR [30.0 (29.0~33.3)]ml and [5.0 (4.0~7.0) nocturia] and group B the 2012 Yanan city science and technology project (serial number: 2012KW-15 grant.[IPSS9.0) (8.0~11.0), QOL3.0 (3.0~4.0), Qmax10.0 (9.0~11.0) ml/s, PVR34.5 (28.8~36.3) ml, nocturia (5.0~8.0)] 6 times were not statistically significant (P0.0167) of.A group and C group ([IPSS18.0 16.8~21.0), QOL4.0 (4.0~5.0), Qmax7.0 (6.0~7.0) ml/s, PVR45.5 (38.0~57.8) ml, nocturia (6.0~9.3) 7.5 times compare each index had statistical significance (P0.0167) in group.B and C indexes had statistical significance (P0.0167). We observed the bladder wall showed: three cases of bladder wall were thickened, rough.
6 months after operation, A group IPSS[7.0 (5.0~9.0)], QOL[3.0 (2.0~3.0)] [IPSS8.0 and B group (7.0~9.0), QOL3.0 (2.0~4.0) "was not statistically significant (P0.0167). The A group Qmax[14.0 (11.8~16.0)]ml/s, PVR[25.0 (21.0~29.0)]ml and nocturia [4.0 (3.0~5.3)] [Qmax12.0 times better than that of group B (10.0~13.0) ml/s, PVR28.0 (23.0~35.3) ml, nocturia 5.5 times (4.0~7.0)] (P0.0167).B group was significantly better than that of C group ([IPSS15.5 13.0~18.0), QOL4.0 (3.0~5.0), Qmax9.0 (7.0~11.0) ml/s, PVR34.5 (27.5~46.3). Nocturia 7 times (6.0~8.0)] (P0.0167).A groups also were better than those of group C (P0.0167).A group, B group of bladder wall thickness; bladder wall thickening, rough; C group of bladder wall thickening, rough.
12 months after operation, A group, IPSS [4.0 (3.0~5.0)], QOL [1.5 (1.0~2.0)], Qmax[18.0 (16.0~20.0]ml/s), PVR [14.0 (10.0~16.0)]ml and [1.0 (1.0~2.0) nocturia] time was better than that of group B (7.0~9.0 [IPSS8.0), QOL3.0 (2.0~3.0). Qmax14.0 (13.0~16.0) ml/s, PVR18.0 (15.0~21.0) ml, nocturia 3 times (2.0~4.0)] (P0.0167).B group was significantly better than that of C group ([IPSS13.0 11.8~16.0), QOL4.0 (3.0~4.0), Qmax10.0 (8.0~12.3) ml/s, PVR25.0 (20.0~28.0) ml), nocturia 4 (3.0~5.3) time] (P0.0167). We observed the bladder wall display: A group of bladder wall is generally smooth, no thickening, rough; bladder wall thickness in B group; C group of bladder wall thick, coarse.
[Conclusion]
1. long term follow-up showed that the IPSS was less than 20 points and the residual urine volume was less than 50ml. However, B-ultrasound showed a small volume of BPH that had changed in the bladder wall, and the quality of life was the best after early operation.
2. the choice of surgery in the early stage of bladder wall morphological changes may be the best operation time for the treatment of small volume BPH.
3. the morphological changes of the bladder wall may be used as a general indication to judge the timing of small volume BPH surgery.

【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.8


本文编号：1729329