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目的评价前列腺良性增生(BPH)药物治疗无效后,行前列腺动脉栓塞(PAE)治疗的安全性,发病率及短期、中期疗效。材料与方法本前瞻性研究经过了机构审查委员会批准,所有参与者签署了书面知情同意书。选择存在6个月药物治疗无效的、中重度下尿路症状的50岁以上男性BPH病人。大部分病例的PAE经单股动脉路径注入非球形的80~180μm(平均100μm)及180~300μm(平均200μm)的聚乙烯醇微粒。评价PAE后24个月内的有效变量:国际前列腺增生症状评分(IPSS)、生存质量(QOL)评分、最大尿流量,残余尿容积,国际勃起功能指数(IIEF-5)评分、前列腺体积和前列腺特异性抗原水平。Kaplan-Meier法及伴有自回归干扰的随机效应广义最小二乘法回归。结果连续选择了89例病人(平均年龄74.1岁)。其中86例病人成功实施了PAE(97%)。6个月时54例的临床症状改善累积率为78%,12个月时29例的为76%。PAE治疗1个月后随访,IPSS降低了10分,QOL分数降低了2分,最大尿流量增加了38%,前列腺体积减少了20%,残余尿容积减少了30mL,IIEF分数增加了0.5分(差异均有统计学意义,P<0.01)。观察期一直维持上述变化。一个主要的并发症为腔内坏死组织附着在膀胱上,仅需简单的手术可以去除,不必膀胱壁的重建。结论PAE安全有效、并发症发生率低,不导致性功能障碍,能够减小前列腺体积,从而良好地控制中短期的症状。
Objective To evaluate the safety, morbidity and short-term and medium-term efficacy of prostatic arterial embolism (PAE) after the treatment of benign prostatic hyperplasia (BPH) is ineffective. Materials and Methods The prospective study was approved by the institutional review board and all participants signed a written informed consent form. Patients with BPH over 50 years of age who had 6 months of medication ineffective, moderate-to-severe lower urinary tract symptoms were selected. In most cases, non-spherical PAE was infused with 80-180 μm (100 μm average) and 180-300 μm (200 μm average) polyvinyl alcohol particles via a single arterial route. Valid variables within 24 months after PAE assessment: International Prostate Symptom Score (IPSS), Quality of Life (QOL) score, Maximum Urinary Flow, Residual Urine Volume, International Index of Erectile Function (IIEF-5), Prostate Volume and Prostate Specific antigen level. Kaplan-Meier method and random effects generalized least squares regression with autoregressive interference. Results A total of 89 consecutive patients (mean age, 74.1 years) were selected. Eighty-six of these patients successfully achieved PAE (97%). The cumulative improvement in clinical symptoms at 54 months was 78% at 6 months, compared with 76% at 29 months at 12 months. After 1 month of PAE treatment, the IPSS decreased by 10 points, the QOL score decreased by 2 points, the maximum urinary flow increased by 38%, the prostate volume decreased by 20%, the residual urinary volume decreased by 30mL, the IIEF score increased by 0.5 point The differences were statistically significant, P <0.01). The observation period has been to maintain these changes. A major complication is the attachment of necrotic tissue in the bladder to the bladder, which can be removed with a simple procedure without the reconstruction of the bladder wall. Conclusions PAE is safe and effective with low complication rate, does not cause sexual dysfunction, can reduce the volume of prostate, and thus can control short-term symptoms.