【摘要】：目的：通過觀察前列腺按摩后良性前列腺增生（benign prostatic hyperplasia，BPH）患者在前列腺特異性抗原（prostate specific antigen，PSA）與組織學(xué)上的變化，明確前列腺按摩對良性前列腺增生患者的PSA與組織學(xué)的影響，以及前列腺按摩對PSA的影響與組織學(xué)的影響之間的內(nèi)在關(guān)系。 方法：選取我科2013年6月至2013年12月收治的需行經(jīng)尿道前列腺電切術(shù)（Transurethral Resection of Prostate，TURP）的良性前列腺增生患者60例作為研究對象，術(shù)前經(jīng)直腸指診（digital rectal examination，DRE）的體格檢查，國際前列腺癥狀評分（international prostate symptom score，I-PSS）表的問卷調(diào)查，生活質(zhì)量指數(shù)（quality of life，QOL）評分表的問卷調(diào)查， PSA的化驗檢查，最大尿流率（Maximum Urinary Flow Rate，Qmax）的測定，殘余尿量（Residual urine volume，，RUV）的檢測，通過經(jīng)直腸超聲（transrectal ultrasonography，TRUS）測量出前列腺體積的大小、計算機斷層掃描（computed tomography，CT）檢查前列腺或磁共振成像（magnetic resonance imaging，MRI)檢查前列腺等確診為良性前列腺增生，術(shù)后病理診斷確認為良性前列腺增生的患者。對符合納入標準的60例良性前列腺增生患者隨機分為2組。A組為試驗組共30例，B組為對照組共30例。試驗組的良性前列腺增生患者入院第二天清晨空腹檢測血清PSA，然后進行第一次前列腺按摩，按摩后1小時、24小時分別檢測一次血清PSA，然后進行經(jīng)尿道前列腺電切術(shù)，術(shù)前再進行第二次前列腺按摩，按摩后進行手術(shù)，手術(shù)結(jié)束后，收集切除的前列腺增生組織，放入標本袋，并在標本袋上注明時間和患者編號，統(tǒng)一送病理學(xué)檢查。對照組的良性前列腺增生患者入院第二天清晨空腹檢測血清PSA，不進行前列腺按摩，入院第二天清晨空腹檢測完血清PSA后1小時、24小時分別檢測一次血清PSA，然后進行經(jīng)尿道前列腺電切術(shù)，術(shù)前不進行前列腺按摩，手術(shù)結(jié)束后，收集切除的前列腺增生組織，放入標本袋，并在標本袋上注明時間和患者編號，統(tǒng)一送病理學(xué)檢查。 結(jié)果： （1）試驗組入院第二天清晨空腹與第一次前列腺按摩后1小時的血清前列腺特異抗原的均值±標準差比較，差異無統(tǒng)計學(xué)意義（P＞0.05）。試驗組入院第二天清晨空腹與第一次前列腺按摩后24小時的血清前列腺特異抗原的均值±標準差比較，差異有統(tǒng)計學(xué)意義（P＜0.01）。試驗組第一次前列腺按摩后1小時與24小時的血清前列腺特異抗原的均值±標準差比較，差異有統(tǒng)計學(xué)意義（P＜0.01）。 （2）對照組入院第二天清晨空腹的與入院第二天清晨空腹檢測完血清前列腺特異抗原后1小時的血清前列腺特異抗原的均值±標準差比較，差異無統(tǒng)計學(xué)意義（P＞0.05）。對照組入院第二天清晨空腹的與入院第二天清晨空腹檢測完血清前列腺特異抗原后24小時的血清前列腺特異抗原的均值±標準差比較，差異無統(tǒng)計學(xué)意義（P＞0.05）。對照組入院第二天清晨空腹檢測完血清前列腺特異抗原后1小時與24小時的血清前列腺特異抗原的均值±標準差比較，差異無統(tǒng)計學(xué)意義（P＞0.05）。 （3）試驗組與對照組入院第二天清晨空腹的血清前列腺特異抗原的均值±標準差兩者比較，差異無統(tǒng)計學(xué)意義（P＞0.05）。試驗組第一次前列腺按摩后1小時與對照組入院第二天清晨空腹檢測完血清前列腺特異抗原后1小時的血清前列腺特異抗原的均值±標準差兩者比較，差異無統(tǒng)計學(xué)意義（P＞0.05）。試驗組第一次前列腺按摩后24小時與對照組清晨空腹檢測完血清前列腺特異抗原后24小時的血清前列腺特異抗原的均值±標準差兩者比較，差異有統(tǒng)計學(xué)意義（P＜0.01）。 （4）試驗組從入院第二天清晨空腹檢測的，到第一次前列腺按摩后1小時檢測的血清前列腺特異抗原的均值±標準差的變化不大，從第一次前列腺按摩后1小時到第一次前列腺按摩后24小時的檢測的血清前列腺特異抗原的均值±標準差呈上升趨勢。 （5）對照組從入院第二天清晨空腹檢測的、到入院第二天清晨空腹檢測完血清前列腺特異抗原后1小時、24小時分別檢測的血清前列腺特異抗原的均值±標準差的折線圖基本成一條略有起伏的水平線，變化很小。 （6）試驗組患者的病理學(xué)檢查發(fā)現(xiàn)良性前列腺增生的組織學(xué)標本中有前列腺腺管上皮、前列腺腺體上皮或前列腺腺腔的機械性損傷，并且伴有非細菌性炎癥反應(yīng)的發(fā)生，例如中性粒細胞的浸潤。 （7）對照組患者的病理學(xué)檢查發(fā)現(xiàn)良性前列腺增生的組織學(xué)標本中沒有前列腺腺管上皮、前列腺腺體上皮或前列腺腺腔的機械性損傷，并且也不伴有非細菌性炎癥反應(yīng)的發(fā)生，例如中性粒細胞的浸潤。 結(jié)論： 第一，前列腺按摩對PSA的影響是有時間性的，在前列腺按摩后1小時立即進行PSA的檢查，檢查的結(jié)果與清晨空腹未行前列腺按摩的檢查的結(jié)果差別不大，不影響檢查結(jié)果的準確性；但是如果前列腺按摩24小時后再抽血檢查，那么PSA顯著升高。 第二，前列腺按摩直接導(dǎo)致患者的前列腺增生組織的機械性損傷，使前列腺組織的前列腺腺管上皮、前列腺腺體上皮或前列腺腺腔及由基底膜、基底細胞與內(nèi)皮細胞構(gòu)成的生理屏障被破壞，并且伴有非細菌性炎癥反應(yīng)的發(fā)生，例如中性粒細胞的浸潤。 第三，前列腺按摩對PSA的影響與組織學(xué)的影響的內(nèi)在關(guān)系是：前列腺按摩導(dǎo)致了前列腺組織的機械性損傷和非細菌性炎癥反應(yīng)，破壞了前列腺腺管及原有的生理屏障的完整性，使前列腺腺管及腺泡內(nèi)的PSA滲漏進入血液，炎癥也使得淋巴管、毛細血管的通透性增高，使PSA易于進入血液循環(huán)，從而引起血清PSA的升高。 第四，前列腺按摩對PSA的影響的時間性對我們的臨床工作有一定的指導(dǎo)意義，由于前列腺按摩后1小時檢查的PSA的結(jié)果與清晨空腹未按摩前列腺檢查的PSA的結(jié)果差別很小，差異無統(tǒng)計學(xué)意義，說明前列腺按摩后1小時及時抽血檢查PSA不影響其檢查結(jié)果的準確性，不會影響對疾病的判斷。因此在臨床上，我們不必等到前列腺按摩后7天再檢查PSA的結(jié)果，可以用前列腺按摩后1小時檢查的PSA的結(jié)果來代替前列腺按摩后7天檢查的PSA的結(jié)果。從而使我們盡早得到PSA的檢查結(jié)果，盡早對與PSA相關(guān)的疾病進行診斷與治療。 第五，前列腺按摩對良性前列腺增生的組織學(xué)的影響對我們的臨床工作有一定的指導(dǎo)意義，提示我們在為病人做前列腺按摩時，動作要盡量輕柔，盡量減少前列腺按摩對前列腺組織的機械性損傷。
[Abstract]:Objective: To observe the changes of prostate specific antigen (PSA) and histology in patients with benign prostatic hyperplasia (BPH) after prostate massage, and to clarify the effect of prostate massage on PSA and histology in patients with BPH, and the effect of prostate massage on PSA. The intrinsic relationship between histology and histology.
Methods: 60 patients with benign prostatic hyperplasia who underwent transurethral resection of prostate (TURP) from June 2013 to December 2013 in our department were selected as the study subjects. The physical examination of DRE and the international prostate symptom score (IPS) were performed before TURP. State symptom score, I-PSS questionnaire, quality of life (QOL) questionnaire, PSA test, Maximum Urinary Flow Rate (Qmax), Residual urine volume (RUV), measured by transrectal ultrasonography (TRUS). The size of the prostate, computed tomography (CT) examination of the prostate or magnetic resonance imaging (MRI) examination of the prostate and other confirmed benign prostatic hyperplasia, postoperative pathological diagnosis of benign prostatic hyperplasia confirmed patients. Patients in group A and group B were randomly divided into two groups: 30 in the experimental group and 30 in the control group. Patients in the experimental group were tested for serum PSA on an empty stomach in the morning of the second day after admission, and then were given the first prostate massage. Serum PSA was detected one hour and 24 hours after the first prostate massage. After the operation, the prostate hyperplasia tissues were collected and put into the specimen bag. The specimen bag was marked with the time and the patient's number and sent to pathological examination. The control group of benign prostatic hyperplasia patients were admitted to hospital the next morning fasting serum PSA test, without prostate massage, admission. The next morning, serum PSA was detected one hour after fasting and 24 hours after fasting, and then transurethral resection of the prostate was performed. No prostatic massage was performed before operation.
Result:
(1) There was no significant difference in the mean (+) standard deviation of serum prostate-specific antigen between the experimental group and the control group in the morning of admission and one hour after the first prostate massage (P > 0.05). The difference was statistically significant (P
(2) There was no significant difference in the mean [standard deviation] of serum prostate-specific antigen between the control group and the control group (P > 0.05). There was no significant difference in the mean [standard deviation] of serum prostate-specific antigen between the two groups. There was no significant difference in the mean (+) standard deviation of serum prostate-specific antigen 24 hours after prostate-specific antigen test (P > 0.05). There was no significant difference in the mean (+) standard deviation of serum prostate-specific antigen between the control group and the control group at 1 hour and 24 hours after fasting detection of serum prostate-specific antigen (P > 0.05). > 0.05).
(3) There was no significant difference between the experimental group and the control group in the mean (+ standard deviation) of serum prostate-specific antigen in the morning of admission (P > 0.05). There was no significant difference between the two groups (P > 0.05). The difference between the two groups was statistically significant (P < 0.01).
(4) There was no significant change in the mean [standard deviation] of serum prostate-specific antigen detected in the experimental group from the morning of admission to one hour after the first prostate massage, and the mean [standard deviation] of serum prostate-specific antigen detected from one hour after the first prostate massage to 24 hours after the first prostate massage. Upward trend.
(5) In the control group, the mean [standard deviation] of serum prostate-specific antigen measured 24 hours after fasting in the morning of admission and 1 hour after fasting in the morning of admission was basically a slightly fluctuating horizontal line, with little change.
(6) Histological examination of the experimental group revealed mechanical damage to the prostatic duct epithelium, the prostatic gland epithelium, or the prostatic cavity in the benign prostatic hyperplasia specimens, accompanied by non-bacterial inflammatory reactions such as neutrophil infiltration.
(7) Pathological examination of the control group revealed no mechanical damage to the prostatic duct epithelium, the prostatic gland epithelium, or the prostatic cavity in the histological specimens of benign prostatic hyperplasia, and no non-bacterial inflammatory reaction, such as infiltration of neutrophils.
Conclusion:
Firstly, the effect of prostate massage on PSA is time-consuming. PSA examination is performed immediately one hour after prostate massage. The results of the examination are not significantly different from those of fasting prostate massage in the morning, which does not affect the accuracy of the results. But if prostate massage is performed 24 hours later, PSA is significantly increased. High.
Secondly, prostatic massage directly causes mechanical damage to the prostatic hyperplasia tissues of the patient, destroying the physiological barrier composed of the prostatic duct epithelium, prostatic gland epithelium or prostatic gland cavity and the basement membrane, basal cells and endothelial cells, and accompanying the occurrence of non-bacterial inflammation, such as neutral Granulocyte infiltration.
Thirdly, the intrinsic relationship between the effect of prostate massage on PSA and histology is that prostate massage leads to mechanical damage and non-bacterial inflammation of prostate tissue, destroys the integrity of prostate gland duct and the original physiological barrier, and makes the prostate gland duct and acinar PSA leak into the blood, and inflammation also causes gonorrhea. The increased permeability of the capillary tube makes the PSA easy to enter the blood circulation, resulting in the increase of serum PSA.
Fourthly, the timeliness of the effect of prostate massage on PSA has a certain guiding significance to our clinical work. Because the results of PSA examination one hour after prostate massage and those of PSA examination one hour after prostate massage in the morning are not significantly different from those of fasting prostate massage, the difference is not statistically significant. So clinically, we don't have to wait until 7 days after prostate massage to check the results of PSA. We can use the results of PSA after prostate massage to replace the results of PSA after 7 days after prostate massage. We should diagnose and treat PSA related diseases as early as possible.
Fifth, the effect of prostate massage on the histology of benign prostatic hyperplasia has a certain guiding significance to our clinical work, suggesting that when we do prostate massage for patients, the movement should be as gentle as possible to minimize the prostatic tissue mechanical injury caused by prostate massage.
【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

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