良性前列腺增生术后前列腺症状改善的相关影响因素分析

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摘要 目的：探讨影响良性前列腺增生（BPH）患者经双极等离子前列腺电切术（BPRP）或前列腺钬激光剜除术（HoLEP）治疗后前列腺症状改善状况的相关因素分析。方法：回顾性分析2018年10月—2021年10月期间武汉同济医院收治的240名诊断为BPH患者的术前、术后资料、部分患者术前尿流动力学检查结果、评估患者国际前列腺症状评分（IPSS）、膀胱过度活动症（OAB）、生活质量评分（QoL）,记录手术方式及围手术期相关资料,进行术后6个月的电话随访并记录相关随访资料。240例患者中有124例完善了尿流动力学检查,对所得数据进行统计分析,探讨影响BPH患者手术后前列腺症状改善状况的相关影响因素。以IPSS改善成功定义为（术后/术前）≤0.50,将患者分为改善组：A组（190例）与改善不佳组：B组（50例）。结果：所有符合纳入标准的240例患者手术均取得成功,其中178例患者接受了HoLEP术,62例患者接受了BPRP术。年龄、进展病程、体质指数（BMI）、空腹血糖（FBG）、总胆固醇（TC）、甘油三酯（TG）、谷草转氨酶（AST）、谷丙转氨酶（ALT）、血清白蛋白（ALB）、血清肌酐（Scr）、肾小球率过滤（GFR）、术后IPSS、术前术后QoL、术前术后OAB、手术时长、留置导尿管时间、住院时间、术前尿潴留、心血管疾病史、脑梗史、糖尿病史、手术方式、Qmax、FDV、PVR、Pqmax、SDV、BOOI、BCI均不是BPH患者术后IPSS改善不佳的危险因素,病程延长（P<0.001）、前列腺体积（P=0.024）、总血清前列腺特异性抗原（TPSA）（P=0.002）、游离血清前列腺特异性抗原（FPSA）（P=0.006）、术前IPSS增高（P=0.015）以及血红蛋白（Hb）降低（P=0.016）是术后IPSS改善不佳的危险因素,其中术前IPSS（P=0.006）和PV增高（P=0.035）是独立的危险因素。结论：术前前列腺体积增大、术前IPSS评分高的患者经BPRP或HoLEP治疗后IPSS改善较差,要对此类患者进行术前沟通,告知患者术后存在前列腺症状不能改善的可能性较大,必要时术后需继续用药以缓解患者症状。

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	李备
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	张安

关键词 ：前列腺增生症, 前列腺体积, 尿流动力学, 前列腺特异性抗原

Abstract：Objective This study aimed to analyze the factors influencing improvement in prostate symptoms in patients with benign prostatic hyperplasia (BPH) treated with either bipolar transurethral resection of the prostate (BPRP) or holmium laser enucleation of the prostate (HoLEP). Methods We conducted a retrospective analysis of data from 240 patients diagnosed with BPH and treated between October 2018 and October 2021 at Tongji Hospital, Wuhan. Preoperative and postoperative data were reviewed, including urodynamic parameters in some patients, International Prostate Symptom Score (IPSS), Overactive Bladder (OAB) symptoms, Quality of Life (QoL) scores, surgical approach, and perioperative information. A telephone follow-up was performed at 6 months post-surgery to record relevant follow-up data. Among the 240 patients, 124 completed urodynamic examinations, and data from these patients were statistically analyzed to explore factors influencing postoperative improvement in prostate symptoms. Improvement in IPSS was defined as (postoperative/preoperative) ≤0.50, and patients were divided into the Improvement Group (Group A, 190 cases) and the Poor Improvement Group (Group B, 50 cases). Results All 240 patients who met the inclusion criteria had successful surgeries, with 178 patients undergoing HoLEP and 62 patients undergoing BPRP. Age, disease duration, BMI, FBG, TC, TG, AST, ALT, ALB, Csr, GFR, postoperative IPSS, preoperative and postoperative QoL, preoperative and postoperative OAB, surgical duration, indwelling catheter time, length of hospital stay, preoperative urinary retention, history of cardiovascular disease, history of cerebral infarction, history of diabetes, surgical approach, Qmax, FDV, PVR, Pqmax, SDV, BOOI, and BCI were not identified as risk factors for poor postoperative IPSS improvement. Prolonged disease duration (P<0.001), prostate volume (PV) (P=0.024), total prostate-specific antigen (TPSA) (P=0.002), free prostate-specific antigen (FPSA) (P=0.006), elevated preoperative IPSS (P=0.015), and decreased hemoglobin (Hb) (P=0.016) were identified as risk factors for poor postoperative IPSS improvement, with preoperative IPSS (P=0.006) and elevated PV (P=0.035) being independent risk factors. Conclusion Patients with larger prostate volumes and higher preoperative IPSS scores may experience poorer IPSS improvement after BPRP or HoLEP treatment for BPH. These patients should be counseled before surgery regarding the possibility of persistent prostate symptoms postoperatively, and medication may be necessary to alleviate symptoms if required.

Key words： benign prostatic hyperplasia prostate volume urodynamics prostate-specific antigen

收稿日期: 2023-09-12

中图分类号:

R697+.3

基金资助:湖北省卫生健康委2021—2022年度立项项目“钬激光碎石术联合经尿道等离子电切术治疗前列腺增生症合并膀胱大结石的效果”（WJ2021Q019)

通讯作者: 陈园,E-mail：chenyuan55@126.com

引用本文:

李备, 陈园, 张安. 良性前列腺增生术后前列腺症状改善的相关影响因素分析[J]. 湖南师范大学学报(医学版), 2023, 20(6): 55-59. LI Bei, CHEN Yuan, ZHANG An. Analysis of Factors Influencing Improvement in Prostate Symptoms After Benign Prostatic Hyperplasia Surgery. HuNan ShiFan DaXue XueBao(YiXueBan), 2023, 20(6): 55-59.

链接本文:

http://yxb.hunnu.edu.cn/CN/ 或 http://yxb.hunnu.edu.cn/CN/Y2023/V20/I6/55

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