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目的探讨经直肠高强度聚焦超声(high-intensity focused ultrasound,HIFU)治疗良性前列腺增生(BPH)的有效性和安全性。方法对150例BPH患者采用Sonablate 500型“经直肠超声聚能刀”进行前列腺消融术。在术前、术后30min,1、2、6和12个月,经直肠超声观察前列腺和前列腺部尿道的影像学变化,通过尿液分析、国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)和残余尿量(PVR)进行疗效评估,同时观察术后并发症。23例术后12个月行排尿期膀胱尿道造影。结果对143例进行了12个月的观察随访,术后IPSS评分和QOL评分降低,PVR减少,Qmax明显提高(P<0.01),前列腺体积缩小(P<0.05)。前列腺消融时间25～90min。术后留置尿管时间为3～19d,7例术后反复排尿困难、药物治疗效果不佳者行TURP手术,3例患者出现附睾炎,1例术后15d发生尿道直肠瘘。术后经直肠超声观察和膀胱尿道造影,证实术后前列腺部尿道较术前明显增宽。结论“经直肠超声聚能刀”前列腺消融术,能对前列腺组织进行选择性破坏,具有微创(无血手术)、安全和并发症少等优点。对前列腺中叶增生明显者可联合TURP治疗。“经直肠超声聚能刀”治疗BPH近期疗效满意,远期疗效有待进一步观察。
Objective To investigate the efficacy and safety of transrectal high-intensity focused ultrasound (HIFU) in the treatment of benign prostatic hyperplasia (BPH). Methods 150 cases of BPH patients were treated with Sonablate 500 “transrectal ultrasonic energy knife” for prostate ablation. The preoperative, postoperative 30min, 1, 2, 6 and 12 months, transrectal ultrasound was used to observe the imaging changes of the prostatic and prostatic urethra. Urine analysis, International Prostate Symptom Score (IPSS), Quality of Life Scale ), Maximum flow rate (Qmax) and residual urine volume (PVR) were evaluated. The postoperative complications were also observed. Twenty-three patients underwent urinary bladder and urethra at 12 months after operation. Results 143 patients were followed up for 12 months. The IPSS score and QOL score decreased, PVR decreased, Qmax increased significantly (P <0.01), prostate volume decreased (P <0.05). Prostate ablation time 25 ~ 90min. Postoperative urethral catheterization time was 3 ~ 19d, 7 patients had repeated dysuria after operation, TURP operation was performed with poor effect of drug treatment, epididymitis occurred in 3 patients and urethral rectal fistula occurred in 1 patient 15 days after operation. Postoperative transrectal ultrasound and bladder urethroplasty confirmed the postoperative prostate urethra was significantly wider than before surgery. Conclusion “Transrectal ultrasonic knife” prostate ablation, can selectively damage the prostate tissue, with minimally invasive (no blood surgery), less safety and complications. Prostate hyperplasia can be combined with TURP treatment. “Transrectal ultrasonic energy knife” treatment of BPH recent satisfactory results, long-term efficacy remains to be further observed.