良性前列腺增生课件

1、良性前列腺增生Benign Prostatic Hyperplasia,BPH1良性前列腺增生Benign Prostatic Hyper2022/10/15The First Hospital of Xinxiang Medical College2前列腺的位置2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College3概述BPH又称为前列腺肥大(Prostate Enlargement)BPH是指腺上皮细胞的增多，而非细胞的肥大BPH是老年男性常见疾病北方地区的发病率高于南方通

2、常前列腺从3540岁开始增生，50岁出现症状，60岁需要进行有效的治疗2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College4病因前列腺发育依赖于功能性睾丸的存在“双氢睾酮(DHT) ”学说(70年Wilson提出) 基质与上皮的相互作用性激素与基质-上皮间的相互作用双氢睾酮学说示意图2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College5病理通常将前列腺分为移

3、行带(尿道周围腺体、占5%)、外周带、中央带增生的部分主要是尿道周围腺体增生的腺体压迫外周带成为外科包膜增生结节：基质型、腺泡型、混合型2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College6病理增生使前列腺段尿道弯曲、伸长、狭窄，导致膀胱出口（BOO）梗阻梗阻代偿期：膀胱逼尿肌肥厚 梗阻失代偿期：充溢性尿失禁、上尿路积水扩张、代谢产物潴留、尿毒症增生的程度与梗阻程度不一定成正比2022/10/11The First Hospital o2022/10/15The First

4、Hospital of Xinxiang Medical College7临床表现尿频：最早出现的症状排尿困难：最重要的症状尿潴留：梗阻加重的表现其他：血尿、感染、结石、肾积水、疝、痔等(实物标本)BPHBOOLUTS2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College8国际前列腺症状评分(I-PSS)过去1个月症状无1/51/2总是1.尿不尽感0123452.间隔2h0123453.间断排尿0123454.憋尿困难0123455.尿线变细0123456.排尿费力012345

5、7.夜尿次数012345I-PSS：Score(035)2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College9I-PSS Means 0-7 分轻度增生8-19 分中度增生20-35 分重度增生2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College10生活质量评分患者认为其现在的排尿状况非常好好满意半数满意多数不满不满意很痛苦评分0123456生活质量评分：L

6、(06)2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College11诊断50岁以上男性，进行性排尿困难直肠指诊(Digital Rectal Exam,DRE)触及增生前列腺增生：鸡蛋大小 增生：鸭蛋大小 增生：鹅蛋大小客观指标：残余尿、尿流率、PSA测定膀胱镜检或B超检查：直接测定前列腺大小2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College12鉴别诊断膀胱颈

7、纤维化(膀胱颈挛缩)：慢性炎症所致，发病年龄较轻前列腺癌：前列腺坚硬，表面不平，PSA膀胱癌：指膀胱颈附近的膀胱癌，膀胱镜检可以鉴别神经原性膀胱尿道功能障碍：有神经系统损害的病史和体征尿道狭窄：有尿道损伤、感染病史2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College13治疗目的：缓解增生腺体所致的膀胱出口梗阻膀胱出口梗阻(BOO)的原因：增生腺体挤压尿道所致的机械性梗阻增生腺体平滑肌张力所致的动力性梗阻治疗方法：很多2022/10/11The First Hospital o

8、2022/10/15The First Hospital of Xinxiang Medical College14药物治疗-受体阻滞剂 ：降低前列腺平滑肌张力非选择性-受体阻滞剂 ：酚卞明选择性1-受体阻滞剂 ：Hytrin(高特灵)高选择性1a-受体阻滞剂：哈乐5-还原酶抑制剂：Proscar(保列治)阻止睾酮转变为DHT，长期服用可使前列腺体积缩小花粉类制剂：舍尼通 等2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College15手术治疗适应症：残余尿量大于50ml 曾经出现

9、过急性尿潴留大量出血或反复肉眼血尿病人迫切要求，身体状况能耐受手术手术方法：耻骨上前列腺增生腺体摘除术 耻骨后摘除术 经会阴摘除术 经尿道前列腺电切或电汽化术2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College16经尿道增生腺体切除术目前，在全世界范围内，这种治疗方法被公认为治疗BPH的“金标准”(Gold Standard)2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medic

10、al College172022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College182022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College19经尿道增生腺体切除术2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College20前列腺电汽化术TUVPTra

11、nsurethral Vaporization of the Prostate 2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College21前列腺电切除术TURPTransurethral Resection of the Prostate 2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College22电切除的前列腺碎片2022/10/11The First Hosp

12、ital o2022/10/15The First Hospital of Xinxiang Medical College23前列腺钬激光切除术2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College24Laser Ablation of the Prostate 2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College25前列腺两侧叶、中叶增生合并膀胱结石2022/10/11The First Hospital o2022/10/15The First Hospital of Xinxiang Medical College26Treatment of BPHPlaceboWatchful waitingPharmacotherapyAlpha-blockers5alpha reductase inhibitorsPhytotherapySurgeryTURP TUVP TUIPOpen prostatectom