前列腺按摩对良性前列腺增生患者PSA与组织学影响的研究

发布时间：2018-08-14 18:09

【摘要】：目的：通过观察前列腺按摩后良性前列腺增生（benign prostatic hyperplasia，BPH）患者在前列腺特异性抗原（prostate specific antigen，PSA）与组织学上的变化，明确前列腺按摩对良性前列腺增生患者的PSA与组织学的影响，以及前列腺按摩对PSA的影响与组织学的影响之间的内在关系。方法：选取我科2013年6月至2013年12月收治的需行经尿道前列腺电切术（Transurethral Resection of Prostate，TURP）的良性前列腺增生患者60例作为研究对象，术前经直肠指诊（digital rectal examination，DRE）的体格检查，国际前列腺症状评分（international prostate symptom score，I-PSS）表的问卷调查，生活质量指数（quality of life，QOL）评分表的问卷调查， PSA的化验检查，最大尿流率（Maximum Urinary Flow Rate，Qmax）的测定，残余尿量（Residual urine volume，，RUV）的检测，通过经直肠超声（transrectal ultrasonography，TRUS）测量出前列腺体积的大小、计算机断层扫描（computed tomography，CT）检查前列腺或磁共振成像（magnetic resonance imaging，MRI)检查前列腺等确诊为良性前列腺增生，术后病理诊断确认为良性前列腺增生的患者。对符合纳入标准的60例良性前列腺增生患者随机分为2组。A组为试验组共30例，B组为对照组共30例。试验组的良性前列腺增生患者入院第二天清晨空腹检测血清PSA，然后进行第一次前列腺按摩，按摩后1小时、24小时分别检测一次血清PSA，然后进行经尿道前列腺电切术，术前再进行第二次前列腺按摩，按摩后进行手术，手术结束后，收集切除的前列腺增生组织，放入标本袋，并在标本袋上注明时间和患者编号，统一送病理学检查。对照组的良性前列腺增生患者入院第二天清晨空腹检测血清PSA，不进行前列腺按摩，入院第二天清晨空腹检测完血清PSA后1小时、24小时分别检测一次血清PSA，然后进行经尿道前列腺电切术，术前不进行前列腺按摩，手术结束后，收集切除的前列腺增生组织，放入标本袋，并在标本袋上注明时间和患者编号，统一送病理学检查。结果：（1）试验组入院第二天清晨空腹与第一次前列腺按摩后1小时的血清前列腺特异抗原的均值±标准差比较，差异无统计学意义（P＞0.05）。试验组入院第二天清晨空腹与第一次前列腺按摩后24小时的血清前列腺特异抗原的均值±标准差比较，差异有统计学意义（P＜0.01）。试验组第一次前列腺按摩后1小时与24小时的血清前列腺特异抗原的均值±标准差比较，差异有统计学意义（P＜0.01）。（2）对照组入院第二天清晨空腹的与入院第二天清晨空腹检测完血清前列腺特异抗原后1小时的血清前列腺特异抗原的均值±标准差比较，差异无统计学意义（P＞0.05）。对照组入院第二天清晨空腹的与入院第二天清晨空腹检测完血清前列腺特异抗原后24小时的血清前列腺特异抗原的均值±标准差比较，差异无统计学意义（P＞0.05）。对照组入院第二天清晨空腹检测完血清前列腺特异抗原后1小时与24小时的血清前列腺特异抗原的均值±标准差比较，差异无统计学意义（P＞0.05）。（3）试验组与对照组入院第二天清晨空腹的血清前列腺特异抗原的均值±标准差两者比较，差异无统计学意义（P＞0.05）。试验组第一次前列腺按摩后1小时与对照组入院第二天清晨空腹检测完血清前列腺特异抗原后1小时的血清前列腺特异抗原的均值±标准差两者比较，差异无统计学意义（P＞0.05）。试验组第一次前列腺按摩后24小时与对照组清晨空腹检测完血清前列腺特异抗原后24小时的血清前列腺特异抗原的均值±标准差两者比较，差异有统计学意义（P＜0.01）。（4）试验组从入院第二天清晨空腹检测的，到第一次前列腺按摩后1小时检测的血清前列腺特异抗原的均值±标准差的变化不大，从第一次前列腺按摩后1小时到第一次前列腺按摩后24小时的检测的血清前列腺特异抗原的均值±标准差呈上升趋势。（5）对照组从入院第二天清晨空腹检测的、到入院第二天清晨空腹检测完血清前列腺特异抗原后1小时、24小时分别检测的血清前列腺特异抗原的均值±标准差的折线图基本成一条略有起伏的水平线，变化很小。（6）试验组患者的病理学检查发现良性前列腺增生的组织学标本中有前列腺腺管上皮、前列腺腺体上皮或前列腺腺腔的机械性损伤，并且伴有非细菌性炎症反应的发生，例如中性粒细胞的浸润。（7）对照组患者的病理学检查发现良性前列腺增生的组织学标本中没有前列腺腺管上皮、前列腺腺体上皮或前列腺腺腔的机械性损伤，并且也不伴有非细菌性炎症反应的发生，例如中性粒细胞的浸润。结论：第一，前列腺按摩对PSA的影响是有时间性的，在前列腺按摩后1小时立即进行PSA的检查，检查的结果与清晨空腹未行前列腺按摩的检查的结果差别不大，不影响检查结果的准确性；但是如果前列腺按摩24小时后再抽血检查，那么PSA显著升高。第二，前列腺按摩直接导致患者的前列腺增生组织的机械性损伤，使前列腺组织的前列腺腺管上皮、前列腺腺体上皮或前列腺腺腔及由基底膜、基底细胞与内皮细胞构成的生理屏障被破坏，并且伴有非细菌性炎症反应的发生，例如中性粒细胞的浸润。第三，前列腺按摩对PSA的影响与组织学的影响的内在关系是：前列腺按摩导致了前列腺组织的机械性损伤和非细菌性炎症反应，破坏了前列腺腺管及原有的生理屏障的完整性，使前列腺腺管及腺泡内的PSA渗漏进入血液，炎症也使得淋巴管、毛细血管的通透性增高，使PSA易于进入血液循环，从而引起血清PSA的升高。第四，前列腺按摩对PSA的影响的时间性对我们的临床工作有一定的指导意义，由于前列腺按摩后1小时检查的PSA的结果与清晨空腹未按摩前列腺检查的PSA的结果差别很小，差异无统计学意义，说明前列腺按摩后1小时及时抽血检查PSA不影响其检查结果的准确性，不会影响对疾病的判断。因此在临床上，我们不必等到前列腺按摩后7天再检查PSA的结果，可以用前列腺按摩后1小时检查的PSA的结果来代替前列腺按摩后7天检查的PSA的结果。从而使我们尽早得到PSA的检查结果，尽早对与PSA相关的疾病进行诊断与治疗。第五，前列腺按摩对良性前列腺增生的组织学的影响对我们的临床工作有一定的指导意义，提示我们在为病人做前列腺按摩时，动作要尽量轻柔，尽量减少前列腺按摩对前列腺组织的机械性损伤。
[Abstract]:Objective: To observe the changes of prostate specific antigen (PSA) and histology in patients with benign prostatic hyperplasia (BPH) after prostate massage, and to clarify the effect of prostate massage on PSA and histology in patients with BPH, and the effect of prostate massage on PSA. The intrinsic relationship between histology and histology.
Methods: 60 patients with benign prostatic hyperplasia who underwent transurethral resection of prostate (TURP) from June 2013 to December 2013 in our department were selected as the study subjects. The physical examination of DRE and the international prostate symptom score (IPS) were performed before TURP. State symptom score, I-PSS questionnaire, quality of life (QOL) questionnaire, PSA test, Maximum Urinary Flow Rate (Qmax), Residual urine volume (RUV), measured by transrectal ultrasonography (TRUS). The size of the prostate, computed tomography (CT) examination of the prostate or magnetic resonance imaging (MRI) examination of the prostate and other confirmed benign prostatic hyperplasia, postoperative pathological diagnosis of benign prostatic hyperplasia confirmed patients. Patients in group A and group B were randomly divided into two groups: 30 in the experimental group and 30 in the control group. Patients in the experimental group were tested for serum PSA on an empty stomach in the morning of the second day after admission, and then were given the first prostate massage. Serum PSA was detected one hour and 24 hours after the first prostate massage. After the operation, the prostate hyperplasia tissues were collected and put into the specimen bag. The specimen bag was marked with the time and the patient's number and sent to pathological examination. The control group of benign prostatic hyperplasia patients were admitted to hospital the next morning fasting serum PSA test, without prostate massage, admission. The next morning, serum PSA was detected one hour after fasting and 24 hours after fasting, and then transurethral resection of the prostate was performed. No prostatic massage was performed before operation.
Result:
(1) There was no significant difference in the mean (+) standard deviation of serum prostate-specific antigen between the experimental group and the control group in the morning of admission and one hour after the first prostate massage (P > 0.05). The difference was statistically significant (P
(2) There was no significant difference in the mean [standard deviation] of serum prostate-specific antigen between the control group and the control group (P > 0.05). There was no significant difference in the mean [standard deviation] of serum prostate-specific antigen between the two groups. There was no significant difference in the mean (+) standard deviation of serum prostate-specific antigen 24 hours after prostate-specific antigen test (P > 0.05). There was no significant difference in the mean (+) standard deviation of serum prostate-specific antigen between the control group and the control group at 1 hour and 24 hours after fasting detection of serum prostate-specific antigen (P > 0.05). > 0.05).
(3) There was no significant difference between the experimental group and the control group in the mean (+ standard deviation) of serum prostate-specific antigen in the morning of admission (P > 0.05). There was no significant difference between the two groups (P > 0.05). The difference between the two groups was statistically significant (P < 0.01).
(4) There was no significant change in the mean [standard deviation] of serum prostate-specific antigen detected in the experimental group from the morning of admission to one hour after the first prostate massage, and the mean [standard deviation] of serum prostate-specific antigen detected from one hour after the first prostate massage to 24 hours after the first prostate massage. Upward trend.
(5) In the control group, the mean [standard deviation] of serum prostate-specific antigen measured 24 hours after fasting in the morning of admission and 1 hour after fasting in the morning of admission was basically a slightly fluctuating horizontal line, with little change.
(6) Histological examination of the experimental group revealed mechanical damage to the prostatic duct epithelium, the prostatic gland epithelium, or the prostatic cavity in the benign prostatic hyperplasia specimens, accompanied by non-bacterial inflammatory reactions such as neutrophil infiltration.
(7) Pathological examination of the control group revealed no mechanical damage to the prostatic duct epithelium, the prostatic gland epithelium, or the prostatic cavity in the histological specimens of benign prostatic hyperplasia, and no non-bacterial inflammatory reaction, such as infiltration of neutrophils.
Conclusion:
Firstly, the effect of prostate massage on PSA is time-consuming. PSA examination is performed immediately one hour after prostate massage. The results of the examination are not significantly different from those of fasting prostate massage in the morning, which does not affect the accuracy of the results. But if prostate massage is performed 24 hours later, PSA is significantly increased. High.
Secondly, prostatic massage directly causes mechanical damage to the prostatic hyperplasia tissues of the patient, destroying the physiological barrier composed of the prostatic duct epithelium, prostatic gland epithelium or prostatic gland cavity and the basement membrane, basal cells and endothelial cells, and accompanying the occurrence of non-bacterial inflammation, such as neutral Granulocyte infiltration.
Thirdly, the intrinsic relationship between the effect of prostate massage on PSA and histology is that prostate massage leads to mechanical damage and non-bacterial inflammation of prostate tissue, destroys the integrity of prostate gland duct and the original physiological barrier, and makes the prostate gland duct and acinar PSA leak into the blood, and inflammation also causes gonorrhea. The increased permeability of the capillary tube makes the PSA easy to enter the blood circulation, resulting in the increase of serum PSA.
Fourthly, the timeliness of the effect of prostate massage on PSA has a certain guiding significance to our clinical work. Because the results of PSA examination one hour after prostate massage and those of PSA examination one hour after prostate massage in the morning are not significantly different from those of fasting prostate massage, the difference is not statistically significant. So clinically, we don't have to wait until 7 days after prostate massage to check the results of PSA. We can use the results of PSA after prostate massage to replace the results of PSA after 7 days after prostate massage. We should diagnose and treat PSA related diseases as early as possible.
Fifth, the effect of prostate massage on the histology of benign prostatic hyperplasia has a certain guiding significance to our clinical work, suggesting that when we do prostate massage for patients, the movement should be as gentle as possible to minimize the prostatic tissue mechanical injury caused by prostate massage.
【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

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