超选择前列腺动脉栓塞术治疗TURP术后复发的前列腺增生的临床疗效

doi:10.3877/cma.j.issn.2095-5782.2022.02.011

目的

超选择前列腺动脉栓塞术（PAE）治疗经尿道前列腺电切（TURP）复发后的前列腺增生的有效性和安全性分析。

方法

收集2018年1月—2020年8月经TURP治疗前列腺增生复发后行超选择前列腺动脉栓塞术的患者资料10例。采用Seldinger技术穿刺成功后，将5F的Cobra导管选择至左侧髂内动脉造影，采用同轴微导管技术将1.98F微导管超选择至左侧前列腺动脉造影。采用300~500 μm的栓塞微球对前列腺动脉进行栓塞，同样方法处理右侧前列腺动脉。比较术前和术后3、6、12个月的国际前列腺症状评分（IPSS）、生活质量评分（QoL）、最大尿流率（Qmax）和前列腺体积（PV）。

结果

10例患者均成功行双侧前列腺动脉栓塞术，技术成功率100%。术后3、6、12个月的IPSS、QoL、Qmax和PV与术前比较，差别均具有统计学意义（P < 0.001）。术后4例出现了会阴部灼烧感，2例患者出现会阴部疼痛，所有的并发症在发生后1周内消失，无严重的并发症发生。

结论

对于TURP复发后的良性前列腺增生的患者，PAE能明显改善IPSS、QoL、Qmax和PV，疗效明确，并且安全性好。

关键词: 良性前列腺增生, 前列腺动脉栓塞术, TURP, 复发

Objective

To evaluate the efficacy and safety of superselective prostatic arterial embolization (PAE) in the treatment of recurrent benign prostatic hyperplasia after transurethral resection of the prostate (TURP).

Methods

10 patients who underwent superselective prostatic arterial embolization in the treatment for recurrent benign prostatic hyperplasia after TURP from January 2018 to August 2020 were collected. After successful puncture with the Seldinger technique, the 5F Cobra catheter was selected to the left internal iliac arteriography, and the coaxial microcatheter technology was used to superselect the 1.98F microcatheter to the left prostatic artery. 300-500 μm microspheres was used to embolize the prostate artery, and the right prostate artery was processed in the same way. IPSS, QoL, maximum urinary flow rate and prostate volume were compared between before PAE and 3 months, 6 months, and 12 months after PAE.

Results

10 patients successfully underwent bilateral prostatic artery embolization, and the technical success rate was 100%. The IPSS, QoL, maximum urinary flow rate and prostate volume at 3 months, 6 months, and 12 months after PAE were significantly different from those before PAE (P < 0.001). 4 cases developed perineal burning sensation, and 2 cases developed perineal pain. All complications disappeared within 1 week, and no serious complications occurred.

Conclusions

For patients with recurrent benign prostatic hyperplasia after TURP, PAE can significantly improve IPSS, QoL, maximum urinary flow rate and prostate volume, it is a safe and effective method.

Key words: Benign prostatic hyperplasia, Prostatic artery embolization, TURP, Recurrence

表1 10例患者术前的基本资料

参数	最小值	最大值	平均值
年龄	65	96	79.2±8.5
术前IPSS	19	25	21.3±2.1
术前QoL	4	6	4.7±0.7
术前Qmax	2	21	9.2±5.0
术前PV（cm³）	85.8	249.6	144.1±61.1

表1 10例患者术前的基本资料

参数	最小值	最大值	平均值
年龄	65	96	79.2±8.5
术前IPSS	19	25	21.3±2.1
术前QoL	4	6	4.7±0.7
术前Qmax	2	21	9.2±5.0
术前PV（cm³）	85.8	249.6	144.1±61.1

图1 患者双侧前列腺动脉DSA图像1A：左侧前列腺动脉造影图像；1B：右侧前列腺动脉造影图像。

表2 10例患者术后参数的变化

参数	术后3个月	术后6个月	术后12个月
IPSS	12.0±2.7	12.3±2.7	12.1±3.8
QoL	3.1±0.6	2.9±1.0	2.4±1.1
Qmax（mL/s）	14.4±2.1	17.5±2.4	16.9±1.9
PV（cm³）	93.4±38.9	85.8±34.2	84.3±37.0

表2 10例患者术后参数的变化

参数	术后3个月	术后6个月	术后12个月
IPSS	12.0±2.7	12.3±2.7	12.1±3.8
QoL	3.1±0.6	2.9±1.0	2.4±1.1
Qmax（mL/s）	14.4±2.1	17.5±2.4	16.9±1.9
PV（cm³）	93.4±38.9	85.8±34.2	84.3±37.0

图2 术前以及术后3、6、12个月的IPSS、QoL、Qmax和PV的变化

表3 术前和术后各参数的比较

参数	时间	时间	95%CI	P值
IPSS	术前	术后3个月	6.67~11.93	< 0.001
		术后6个月	6.37~11.63	< 0.001
		术后12个月	6.57~11.83	< 0.001
QoL	术前	术后3个月	0.82~2.38	< 0.001
		术后6个月	1.02~2.58	< 0.001
		术后12个月	1.52~3.08	< 0.001
Qmax（mL/s）	术前	术后3个月	-7.82~2.54	< 0.001
		术后6个月	-10.90~5.62	< 0.001
		术后12个月	-9.93~4.64	< 0.001
PV（cm³）	术前	术后3个月	10.23~91.25	< 0.001
		术后6个月	16.65~99.88	< 0.001
		术后12个月	18.17~101.41	< 0.001

表3 术前和术后各参数的比较

参数	时间	时间	95%CI	P值
IPSS	术前	术后3个月	6.67~11.93	< 0.001
		术后6个月	6.37~11.63	< 0.001
		术后12个月	6.57~11.83	< 0.001
QoL	术前	术后3个月	0.82~2.38	< 0.001
		术后6个月	1.02~2.58	< 0.001
		术后12个月	1.52~3.08	< 0.001
Qmax（mL/s）	术前	术后3个月	-7.82~2.54	< 0.001
		术后6个月	-10.90~5.62	< 0.001
		术后12个月	-9.93~4.64	< 0.001
PV（cm³）	术前	术后3个月	10.23~91.25	< 0.001
		术后6个月	16.65~99.88	< 0.001
		术后12个月	18.17~101.41	< 0.001

[1]	Rosen RC, Giuliano F, Carson CC. Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH)[J]. Eur Urol, 2005, 47(6): 824-837.
[2]	Picel AC, Hsieh TC, Shapiro RM, et al. Prostatic artery embolization for benign prostatic hyperplasia: patient evaluation, anatomy, and technique for successful treatment[J]. Radiographics, 2019, 39(5): 1526-1548.
[3]	Xiang P, Guan D, Du Z, et al. Efficacy and safety of prostatic artery embolization for benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials[J]. Eur Radiol, 2021, 31(7): 4929-4946.
[4]	Zumstein V, Betschart P, Vetterlein MW, et al. Prostatic artery embolization versus standard surgical treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review and meta-analysis[J]. Eur Urol Focus, 2019, 5(6): 1091-1100.
[5]	Teoh JY, Chiu PK, Yee CH, et al. Prostatic artery embolization in treating benign prostatic hyperplasia: a systematic review[J]. Int Urol Nephrol, 2017, 49(2): 197-203.
[6]	Knight GM, Talwar A, Salem R, et al. Systematic review and meta-analysis comparing prostatic artery embolization to gold-standard transurethral resection of the prostate for benign prostatic hyperplasia[J]. Cardiovasc Intervent Radiol, 2021, 44(2): 183-193.
[7]	Wang XY, Zong HT, Zhang Y.Efficacy and safety of prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: a systematic review and meta-analysis[J]. Clin Interv Aging, 2016, 11: 1609-1622.
[8]	Uflacker A, Haskal ZJ, Bilhim T, et al. Meta-analysis of prostatic artery embolization for benign prostatic hyperplasia[J]. J Vasc Interv Radiol, 2016, 27(11): 1686-1697.
[9]	Bhatia S. Meta-analysis of prostatic artery embolization for benign prostatic hyperplasia-review of 12-month outcomes data[J]. J Vasc Interv Radiol,2017, 28(5): 772.
[10]	Novosel L, Pezelj I, Tomaskovic I,et al. Prostatic artery embolization as a new option in the treatment of lower urinary tract symptoms in benign prostatic hyperplasia-current evidence[J]. Acta Clin Croat, 2018, 57(Suppl 1): 66-70.
[11]	Insausti I, Saez de Ocariz A, Galbete A, et al. Randomized comparison of prostatic artery embolization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia[J]. J Vasc Interv Radiol, 2020, 31(6): 882-890.
[12]	Jiang YL, Qian LJ. Transurethral resection of the prostate versus prostatic artery embolization in the treatment of benign prostatic hyperplasia: a meta-analysis[J]. BMC Urol, 2019, 19(1): 11.
[13]	Radwan A, Farouk A, Higazy A, et al. Prostatic artery embolization versus transurethral resection of the prostate in management of benign prostatic hyperplasia[J]. Prostate Int, 2020, 8(3): 130-133.
[14]	Torres D, Costa NV, Pisco J, et al. Prostatic artery embolization for benign prostatic hyperplasia: prospective randomized trial of 100-300 μm versus 300-500 μm versus 100- to 300 μm + 300- to 500 μm embospheres[J]. J Vasc Interv Radiol, 2019, 30(5): 638-644.
[15]	Goncalves OM, Carnevale FC, Moreira AM, et al. Comparative study using 100-300 Versus 300-500 μm microspheres for symptomatic patients due to enlarged-BPH prostates[J]. Cardiovasc Intervent Radiol, 2016, 39(10): 1372-1378.
[16]	Carnevale FC, Moreira AM, de Assis AM, et al. Prostatic artery embolization for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: 10 years' experience[J]. Radiology, 2020, 296(2): 444-451.

[1]	李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[2]	刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[3]	谢田伟, 庞于樊, 吴丽. 超声引导下不同消融术对甲状腺良性结节体积缩减率、复发率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 80-83.
[4]	张钊, 骆成玉, 张树琦, 何平, 李旭斌. 不同术式治疗早期乳腺癌的效果及并发症发生率、复发率比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 494-497.
[5]	曾繁利, 齐秩凯, 杨贺庆. 两种经Glisson蒂鞘解剖路径肝切除术治疗原发性肝癌的肿瘤学疗效及风险比对[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 525-527.
[6]	高建新, 王啸飞, 于淼, 路夷平. 局部进展期直肠癌新辅助治疗后行ISR术远切缘距离的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 539-543.
[7]	丁志翔, 于鹏, 段绍斌. 血浆BRAF基因检测对腹腔镜右半结肠癌D3根治术中行幽门淋巴结清扫的指导价值[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 570-573.
[8]	李伟, 宋子健, 赖衍成, 周睿, 吴涵, 邓龙昕, 陈锐. 人工智能应用于前列腺癌患者预后预测的研究现状及展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 541-546.
[9]	皮尔地瓦斯·麦麦提玉素甫, 李慧灵, 艾克拜尔·艾力, 李赞林, 王志, 克力木·阿不都热依木. 生物补片修补巨大复发性腹壁切口疝临床疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 624-628.
[10]	周艳, 李盈, 周小兵, 程发辉, 何恒正. 不同类型补片联合Nissen 胃底折叠术修补食管裂孔疝的疗效及复发潜在危险因素[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 528-533.
[11]	公宇, 廖媛, 尚梅. 肝细胞癌TACE术后复发影响因素及预测模型建立[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 818-824.
[12]	焦振东, 惠鹏, 金上博. 三维可视化结合ICG显像技术在腹腔镜肝切除术治疗复发性肝癌中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 859-864.
[13]	邓万玉, 陈富, 许磊波. 肝硬化与非肝硬化乙肝相关性肝癌患者术后无复发生存比较及其影响因素分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 670-674.
[14]	杭丽, 张耀辉, 孙文恺. 参菝抗瘤液对结直肠腺瘤性息肉术后肠道功能、炎症指标及复发情况的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 413-416.
[15]	郭曌蓉, 王歆光, 刘毅强, 何英剑, 王立泽, 杨飏, 汪星, 曹威, 谷重山, 范铁, 李金锋, 范照青. 不同亚型乳腺叶状肿瘤的临床病理特征及预后危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 524-532.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

The effect of superselective prostatic arterial embolization in the treatment of recurrent benign prostatic hyperplasia after TURP

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

The effect of superselective prostatic arterial embolization in the treatment of recurrent benign prostatic hyperplasia after TURP