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目的:探讨储尿期症状明显的重度良性前列腺增生(BPH)患者经尿道前列腺电切术(TURP)后口服M-受体阻滞剂的用药方案及其临床效果。方法:储尿期症状明显的重度BPH患者,TURP 6 h后开始口服酒石酸托特罗定片(2 mg每12 h 1次或4 mg 1次/d),4周后停药,如储尿期症状加重,继续服药2周再停药观察,如此反复直至术后12周。回顾性分析其术前,术后1、4、8、12周IPSS评分(总分、储尿期、排尿期症状评分)、QoL评分、Qmax和排尿后膀胱残余尿(PVR)。结果:临床资料完备病例共106例。其中4周停药后储尿期症状未加重(成功停药)者33例,6~8周成功停药者51例,10~12周成功停药者13例,12周后仍需继续服药者9例。术前,术后1、4、8、12周IPSS总分分别为(25.33±3.45)、(19.33±3.62)、(11.56±2.45)、(8.38±2.08)、(7.74±1.87)分;储尿期IPSS分别为(11.97±1.53)、(10.76±1.82)、(6.16±1.22)、(4.08±1.19)、(3.91±1.15)分;排尿期IPSS分别为(9.80±1.60)、(5.59±1.45)、(3.40±0.92)、(2.85±0.71)、(2.61±0.67)分;QoL评分为(4.70±0.78)、(3.92±0.75)、(2.55±0.74)、(1.83±0.72)、(1.66±0.75)分;除术后12周与术后8周比较外,术前、术后各观察点之间,IPSS各项指标均有显著性差异(P均<0.01)。QoL、Qmax、PVR术后1、4周呈现进行性改善(P均<0.01),4周后变化不再显著(P均>0.05)。结论:储尿期症状明显的重度BPH患者TURP术后持续口服M-受体阻滞剂4~8周可能是治疗其术后储尿期症状的有效方案。
Objective: To investigate the clinical effect of oral M-receptor blocker after transurethral resection of prostate (TURP) in severe benign prostatic hyperplasia (BPH) patients with obvious symptoms during storage. METHODS: Tropsch statin (2 mg every 12 h or 4 mg once daily) was started 6 hours after TURP in patients with severe BPH. Period of symptoms aggravate, continue to take medicine for 2 weeks and then stop observation, so repeatedly until after 12 weeks. The IPSS scores (total score, urinary storage period, voiding symptom score), QoL score, Qmax and urinary bladder residual urine (PVR) were retrospectively analyzed preoperatively and 1, 4, 8 and 12 weeks after operation. Results: There were 106 cases with complete clinical data. Among them, 33 cases were not exacerbated after four weeks’ withdrawal, the symptoms were relieved (successful withdrawal), 51 cases were successfully discontinued in 6-8 weeks, 13 cases were successfully discontinued in 10-12 weeks and still need to be taken after 12 weeks In 9 cases. The total scores of IPSS at preoperative, postoperative 1,4,8,12 weeks were (25.33 ± 3.45), (19.33 ± 3.62), (11.56 ± 2.45), (8.38 ± 2.08) and (7.74 ± 1.87), respectively The urinary IPSS were (11.97 ± 1.53), (10.76 ± 1.82), (6.16 ± 1.22), (4.08 ± 1.19) and (3.91 ± 1.15) respectively. The urinary IPSS were (9.80 ± 1.60) and (5.59 ± 1.45, 3.40 ± 0.92, 2.85 ± 0.71 and 2.61 ± 0.67, respectively; QoL scores were (4.70 ± 0.78), (3.92 ± 0.75), (2.55 ± 0.74) and 1.66 ± 0.75). All indexes of IPSS were significantly different (P <0.01) except for 12 weeks postoperatively and 8 weeks postoperatively. The QoL, Qmax and PVR showed progressive improvement at 1 and 4 weeks (all P <0.01), but no significant changes after 4 weeks (all P> 0.05). CONCLUSIONS: Continuous oral M-blocker administration for 4 to 8 weeks after TURP in patients with severe BPH with obvious symptoms during storage may be an effective treatment for postoperative urinary symptoms.