良性前列腺增生患者术前压力-流率测定的局限性

目的评估良性前列腺增生(BPH)患者术前行压力一流率测定的应用价值。方法BPH患者69例,根据尿动力学检查直线被动尿道阻力关系(PURR)图结果分为膀胱出口梗阻(BOO)组50例,无或可疑BOO组19例,术前行剩余尿、尿流率、膀胱有效容量和压力-流率测定,国际前列腺症状评分(IPSS)、生活质量评分(QOL)。术后3个月复查比较尿动力学指标变化。结果无或可疑BOO组和有BOO组平均Qmax分别为12.8 ml/s和7.6 ml/s,差异有统计学意义(P<0.01),2组年龄、膀胱最大容量、剩余尿、膀胱有效容量、IPSS和QOL等参数差异无统计学意义(P>0.05)。术后2组平均Qmax分别提高了7.2 ml/s和10.8 ml/s,BOO组Qmax提高幅度与无或可疑BOO组比较差异有统计学意义(P<0.05);2组IPSS和QOL与术前比较差异有统计学意义(P<0.05),IPSS和QOL的改善幅度2组间差异无统计学意义(P>0.05)。BOO组术前逼尿肌活动过度21例(42%),无或可疑BOO例组逼尿肌活动过度7例(37%)。BOO组和无或可疑BOO组术后3个月IPSS和QOL等参数改善不明显分别有15例(30%)和6例(32%)。结论压力-流率测定有无BOO,对大部分BPH患者仍有预测疗效的作用;但术前膀胱有效容量大小以及逼尿肌活动过度等因素影响了手术疗效。部分伴严重下尿路症状(LUTS)的BPH患者无BOO,手术疗效满意。术前BPH患者压力-流率测定应有选择应用,结果分析个体化。

The limitations of preoperative pressure-flow rate in the benign prostatic hyperplasia patients

Objective To discuss the clinical value of pressure flow rate in benign prostatic hy- perplasia before surgery.Methods A total of 69 patients with benign prostatic hyperplasia were as- signed to bladder outlet obstruction(BOO)group(n=50)equivocal and no obstruction group(n= 19)according to urodynamic study,flow rate,bladder effective capacity,pressure-flow rate and resi- dual urine as well as international prostate syndrome scale(IPSS)and quality of life(QOL)scale were performed pre-operatively.Patients were followed up for 3 months after operation the flow rate,IP- SS,and QOL.Results There was significant difference in the maximal flow rate(Qmax)between the BOO group and equivocal or no obstruction group pre-operatively(7.6 ml/s vs.12.8 ml/s respec- tively,P<0.01).There was no significantly different in the age,maximal bladder capacity,residual urine,effective bladder capacity,IPSS and QOL between the 2 groups(P>0.05).After operation, Qmax increased by 10.8 ml/s in BOO group and 7.2 ml/s in equivocal or no obstruction group.There was a significance in the improvement of Qmax(P<0.05),while no significance in the improvement of IPSS and QOL between 2 group (P>0.05).However,IPSS and QOL was observed a significant difference compared with pre-operative index in both groups.Twenty-one cases(42%)of detrusor overactivity were found in BOO group,and 7 cases(37%)in the equivocal or no obstruction group.In 15 cases (30%) of BOO group,IPSS and QOL was not significantly improved 3 months after opera- tion.While the same condition was observed in 6 cases(32%)in equivocal or no obstruction group. Conclusions Pressure-flow rate is an effective predictor of curative effect in most BPH patients.The bladder effective capacity and unstable bladder before surgery could influence the curative effect of BPH.Some BPH patients with serious lower urinary tract symptoms but without obstruction may also benefit from surgery.Pressure-flow rate study could be used selectively and the interpretation of re- suits should be individualized.