本文選題：小體積良性前列腺增生癥　切入點：手術(shù)時機　出處：《延安大學(xué)》2014年碩士論文

【摘要】：【目的】 通過比較不同手術(shù)時機小體積良性前列腺增生癥（BPH）患者的住院日、住院費用和術(shù)后國際前列腺癥狀評分（IPSS）、生活質(zhì)量評分（QOL）、最大尿流率（Qmax）、殘余尿（PVR）、夜尿次數(shù)及B超觀察膀胱壁形態(tài)變化，探討小體積BPH患者的最佳手術(shù)時機，以減少這部分BPH患者的并發(fā)癥，保護腎功能，最大程度的提高這部分患者的生活質(zhì)量及減少其遠(yuǎn)期醫(yī)療費用。 【方法】 采用前瞻性對照研究，選取2011年12月—2013年4月期間在延安大學(xué)附屬醫(yī)院泌尿外科就診確診為小體積BPH的患者136例，平均年齡（65.1±5.4）歲，，B超提示其膀胱壁均出現(xiàn)增厚、毛糙改變。根據(jù)術(shù)前IPSS評分及PVR分組，患者IPSS小于20且PVR小于50ml時選擇手術(shù)治療的入選A組，病例30人，平均年齡（62.1±5.2）歲；患者IPSS大于20或PVR大于50ml選擇手術(shù)治療的入選B組，病例30人，平均年齡（63.9±5.7）歲；患者IPSS大于20同時PVR大于50ml選擇手術(shù)治療的入選C組，病例30人，平均年齡（67.4±5.8）歲。三組病例均采用TURP+TURBN術(shù)進行治療。比較三組病例的住院日、住院費用，并對三組病例分別在術(shù)后3個月、6個月、12個月進行隨訪觀察，比較其術(shù)后IPSS、QOL、Qmax、PVR及夜尿次數(shù)，B超觀察其膀胱壁的變化。 【結(jié)果】 三組病例的住院日：A組（6.2±1.3天）小于B組（7.7±1.7天），B組小于C組（10.1±1.9天）（P0.01）。住院費用：A組（6697.3±210.6元）小于B組（7219.3±287.6元），B組小于C組（8272.0±672.2元）（P0.01）。 術(shù)后3個月時，A組的IPSS [8.0(7.0~9.0)]分、QOL [3.0(2.0~4.0)]分、Qmax[11.0(10.0~12.0)]ml/s、PVR [30.0(29.0~33.3)]ml和夜尿次數(shù)[5.0(4.0~7.0)]次與B組本研究得到延安市2012年科技計劃項目（編號：2012KW-15）資助。[IPSS9.0(8.0~11.0)分、 QOL3.0(3.0~4.0)分、 Qmax10.0(9.0~11.0)ml/s、 PVR34.5(28.8~36.3)ml、夜尿次數(shù)6.0(5.0~8.0)次]比較均無統(tǒng)計學(xué)意義（P0.0167）。A組與C組[IPSS18.0(16.8~21.0)分、QOL4.0(4.0~5.0)分、Qmax7.0(6.0~7.0)ml/s、PVR45.5(38.0~57.8)ml、夜尿次數(shù)7.5(6.0~9.3)次]比較各指標(biāo)均有統(tǒng)計學(xué)意義（P0.0167）。B組和C比較各指標(biāo)均有統(tǒng)計學(xué)意義（P0.0167）。B超觀察膀胱壁顯示：三組病例膀胱壁均增厚、毛糙。 術(shù)后6個月時，A組的IPSS[7.0(5.0~9.0)]分、QOL[3.0(2.0~3.0)]分與B組[IPSS8.0(7.0~9.0)分、 QOL3.0(2.0~4.0)分]比較無統(tǒng)計學(xué)意義（P0.0167）。 A組的Qmax[14.0(11.8~16.0)]ml/s、PVR[25.0(21.0~29.0)]ml和夜尿次數(shù)[4.0(3.0~5.3)]次優(yōu)于B組[Qmax12.0(10.0~13.0)ml/s、PVR28.0(23.0~35.3)ml、夜尿次數(shù)5.5(4.0~7.0)次]（P0.0167）。B組各指標(biāo)均優(yōu)于C組[IPSS15.5(13.0~18.0)分、QOL4.0(3.0~5.0)分、Qmax9.0(7.0~11.0)ml/s、PVR34.5(27.5~46.3)、夜尿次數(shù)7.0(6.0~8.0)次]（P0.0167）。A組各指標(biāo)也均優(yōu)于C組（P0.0167）。A組膀胱壁厚；B組膀胱壁增厚、毛糙；C組膀胱壁增厚、毛糙。 術(shù)后12個月時，A組的IPSS [4.0(3.0~5.0)]分、QOL [1.5(1.0~2.0)]分、Qmax[18.0(16.0~20.0)]ml/s、PVR [14.0(10.0~16.0)]ml和夜尿次數(shù)[1.0(1.0~2.0)]次均優(yōu)于B組[IPSS8.0(7.0~9.0)分、 QOL3.0(2.0~3.0)分、 Qmax14.0(13.0~16.0)ml/s、 PVR18.0(15.0~21.0)ml、夜尿次數(shù)3.0(2.0~4.0)次]（P0.0167）。B組各指標(biāo)均優(yōu)于C組[IPSS13.0(11.8~16.0)分、 QOL4.0(3.0~4.0)分、 Qmax10.0(8.0~12.3)ml/s、PVR25.0(20.0~28.0))ml、夜尿次數(shù)4.0(3.0~5.3)次]（P0.0167）。B超觀察膀胱壁顯示：A組膀胱壁普遍較光滑，無增厚、毛糙；B組膀胱壁厚；C組膀胱壁較厚、毛糙。 【結(jié)論】 1.長期隨訪顯示在IPSS小于20分且殘余尿量小于50ml，但B超顯示膀胱壁已發(fā)生改變的小體積BPH患者，早期手術(shù)術(shù)后生活質(zhì)量最好。 2.在出現(xiàn)膀胱壁形態(tài)改變初期時選擇手術(shù)可能是治療小體積BPH的最佳手術(shù)時機。 3.膀胱壁形態(tài)改變可能作為判斷小體積BPH手術(shù)時機的指征普遍應(yīng)用于臨床。
[Abstract]:[Objective]
By comparing the different timing of surgery of small volume benign prostatic hyperplasia (BPH) patients in hospitalization, hospitalization expenses and postoperative International Prostate Symptom Score (IPSS), quality of life score (QOL), maximum urinary flow rate (Qmax), residual urine (PVR), nocturia and ultrasound to observe the morphological changes of the bladder wall. To explore the optimal time for operation of small volume in patients with BPH, in order to reduce the complications in BPH patients, protect renal function, improve the maximum level of this part of the quality of life of patients and reduce the long-term medical expenses.
[method]
A prospective case-control study from December 2011 to April 2013 during the Department of Urology in Affiliated Hospital of Yan'an University diagnosed 136 cases of BPH patients with small volume, average age (65.1 + 5.4) years old, b-tip the bladder wall were thickening, rough change. According to the preoperative IPSS score and PVR group, patients with IPSS less than 20 PVR and less than 50ml selection of surgical treatment in A group, 30 cases, the average age (62.1 + 5.2); patients with IPSS greater than 20 or greater than 50ml PVR selection B group of surgical treatment, 30 cases, the average age (63.9 + 5.7); patients with IPSS greater than 20 and PVR more than 50ml selection group C surgery in the case of 30 people, average age (67.4 + 5.8) years old. Three groups were treated with TURP+TURBN therapy. The three groups were compared the hospitalization days, hospitalization expenses, and three cases were in postoperative 3 months, 6 months, 12 months after the view The changes of IPSS, QOL, Qmax, PVR and nocturia after operation were compared and the bladder wall of the bladder was observed by B ultrasound.
[results]
The hospitalization days of the three groups were: A group (6.2 + 1.3 days) less than B group (7.7 + 1.7 days), group B was less than C group (10.1 + 1.9 days) (P0.01). Hospitalization expenses: A group (6697.3 + 210.6 yuan) was less than B group (7219.3 7219.3 yuan), B group was less than C group (287.6 + 287.6 yuan) (P0.01).
3 months after operation, A group, IPSS [8.0 (7.0~9.0)], QOL [3.0 (2.0~4.0)], Qmax[11.0 (10.0~12.0]ml/s), PVR [30.0 (29.0~33.3)]ml and [5.0 (4.0~7.0) nocturia] and group B the 2012 Yanan city science and technology project (serial number: 2012KW-15 grant.[IPSS9.0) (8.0~11.0), QOL3.0 (3.0~4.0), Qmax10.0 (9.0~11.0) ml/s, PVR34.5 (28.8~36.3) ml, nocturia (5.0~8.0)] 6 times were not statistically significant (P0.0167) of.A group and C group ([IPSS18.0 16.8~21.0), QOL4.0 (4.0~5.0), Qmax7.0 (6.0~7.0) ml/s, PVR45.5 (38.0~57.8) ml, nocturia (6.0~9.3) 7.5 times compare each index had statistical significance (P0.0167) in group.B and C indexes had statistical significance (P0.0167). We observed the bladder wall showed: three cases of bladder wall were thickened, rough.
6 months after operation, A group IPSS[7.0 (5.0~9.0)], QOL[3.0 (2.0~3.0)] [IPSS8.0 and B group (7.0~9.0), QOL3.0 (2.0~4.0) "was not statistically significant (P0.0167). The A group Qmax[14.0 (11.8~16.0)]ml/s, PVR[25.0 (21.0~29.0)]ml and nocturia [4.0 (3.0~5.3)] [Qmax12.0 times better than that of group B (10.0~13.0) ml/s, PVR28.0 (23.0~35.3) ml, nocturia 5.5 times (4.0~7.0)] (P0.0167).B group was significantly better than that of C group ([IPSS15.5 13.0~18.0), QOL4.0 (3.0~5.0), Qmax9.0 (7.0~11.0) ml/s, PVR34.5 (27.5~46.3). Nocturia 7 times (6.0~8.0)] (P0.0167).A groups also were better than those of group C (P0.0167).A group, B group of bladder wall thickness; bladder wall thickening, rough; C group of bladder wall thickening, rough.
12 months after operation, A group, IPSS [4.0 (3.0~5.0)], QOL [1.5 (1.0~2.0)], Qmax[18.0 (16.0~20.0]ml/s), PVR [14.0 (10.0~16.0)]ml and [1.0 (1.0~2.0) nocturia] time was better than that of group B (7.0~9.0 [IPSS8.0), QOL3.0 (2.0~3.0). Qmax14.0 (13.0~16.0) ml/s, PVR18.0 (15.0~21.0) ml, nocturia 3 times (2.0~4.0)] (P0.0167).B group was significantly better than that of C group ([IPSS13.0 11.8~16.0), QOL4.0 (3.0~4.0), Qmax10.0 (8.0~12.3) ml/s, PVR25.0 (20.0~28.0) ml), nocturia 4 (3.0~5.3) time] (P0.0167). We observed the bladder wall display: A group of bladder wall is generally smooth, no thickening, rough; bladder wall thickness in B group; C group of bladder wall thick, coarse.
[Conclusion]
1. long term follow-up showed that the IPSS was less than 20 points and the residual urine volume was less than 50ml. However, B-ultrasound showed a small volume of BPH that had changed in the bladder wall, and the quality of life was the best after early operation.
2. the choice of surgery in the early stage of bladder wall morphological changes may be the best operation time for the treatment of small volume BPH.
3. the morphological changes of the bladder wall may be used as a general indication to judge the timing of small volume BPH surgery.

【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R699.8


本文編號：1729329