尿动力学检查在经尿道前列腺切除术（TURP）中应用的再评估

发布时间：2018-07-11 15:23

  本文选题：前列腺增生 + 尿动力学检查　； 参考：《苏州大学》2014年硕士论文

【摘要】：目的：回顾性分析前列腺增生患者尿动力学检查结果与经尿道前列腺切除术（TURP）后疗效的关系，再评估TURP术前尿流动力学检查的应用价值。 方法：收集2012年1月至2013年5月在苏州大学附属第一医院泌尿外科因良性前列腺增生症（BPH）接受经尿道前列腺切除（TURP）手术的82例患者的临床与随访资料。所有患者术后的病理检查结果为前列腺增生，，并且在术前接受了尿流动力学检查。回顾性分析患者术前、术后3个月时的国际前列腺症状（IPSS）评分、生活质量评分（QOL）、OAB-V8评分、最大尿流率（Q-max）、残余尿量、尿流动力学检查各参数等，从而判断TURP手术疗效与术前尿流动力学检查结果间的相关性。 结果：82例TURP患者术后初次试行拔除导尿管（TWOC）成功率的为90.24%（74/82例）。IPPS评分明显改善（术前19.1±5.5分Vs术后7.1±5.4分，P0.01）；QOL评分明显改善（术前4.3±1.7分Vs术后2.1±1.5分，P0.05）。Q-max分别由术前的9.6±5.2ml/s上升到术后的17.4±4.1ml/s；残余尿量由术前的62.2±27.8ml显著下降到术后的23.2±11.6ml。 Q-max时逼尿肌压力≥40cmH2O患者（共62例），术后初次TWOC成功率98.39%（61/62例），明显高于逼尿肌压力40cmH2O患者的65.00%（13/20例），P0.05；而且，术后主观症状改善更加明显，IPSS评分6.8±4.9分，明显优于40cmH2O患者的IPSS评分10.5±4.5分，P0.05。尿流动力学检查显示，BPH合并OAB患者17例，发生率为20.73%（17/82例），TURP术后OAB症状未见明显缓解。与TURP术前相比较，BPH合并OAB患者，OAB-V8评分分别为18.2±6.2分和15.3±5.8分，P0.05。尿动力学检查并发症方面：有2例检查术后发生菌血症；6例发生严重尿频、尿急、尿痛症状；5例发生肉眼血尿。 结论：1.尿动力学检查提示，Qmax时逼尿肌收缩力正常者，TURP术后不仅IPSS评分显著改善，而且初次TWOC成功率高。2. TURP手术并不能改善BPH患者的OAB症状，术前通过尿动力学检查发现并控制好OAB症状后再手术，效果更好。3.尿动力学检查可能引起严重并发症，应谨慎选择，同时积极对症处理产生的并发症。
[Abstract]:Objective: to retrospectively analyze the relationship between the results of urodynamic examination and the curative effect after transurethral prostatectomy (TURP) in patients with benign prostatic hyperplasia (BPH), and to evaluate the value of urodynamic examination before TURP. Methods: from January 2012 to May 2013, 82 patients undergoing transurethral prostatectomy (TURP) in Urology Department of the first affiliated Hospital of Suzhou University were treated with transurethral prostatectomy (TURP). All patients had benign prostatic hyperplasia (BPH) and underwent urodynamic examination before operation. The International Prostate symptom (IPSS) score, quality of Life score (QOL), OAB-V8 score, maximum flow rate (Q-max), residual urine volume, urodynamic parameters were retrospectively analyzed. Therefore, the correlation between the curative effect of TURP and the results of urodynamic examination before operation was evaluated. Results the successful rate of the first trial removal of urethral catheter (TWOC) in 82 TURP patients was 90.24% (74 / 82). IPPS score was improved significantly (preoperative 19.1 卤5.5 vs 7.1 卤5.4 vs P0.01). QOL scores improved significantly (preoperative 4.3 卤1.7 vs 2.1 卤1.5 vs P0.05) .Q-max increased from 9.6 卤5.2ml/s to 17.4 卤4.1 ml / s, and residual urine volume decreased significantly from 62.2 卤27.8ml to 23.2 卤11.6 ml. In 62 patients with detrusor pressure 鈮

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