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

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

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