章良性前列腺增生

2024/9/18TheFirstHospitalofXinxiangMedicalCollege1前列腺的位置2024/9/18TheFirstHospitalofXinxiangMedicalCollege2概述BPH又称为前列腺肥大(ProstateEnlargement)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常前列腺从35～40岁开始增生，50岁出现症状，60岁需要进行有效的治疗2024/9/18TheFirstHospitalofXinxiangMedicalCollege3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2024/9/18TheFirstHospitalofXinxiangMedicalCollege4病理通常将前列腺分为移行带(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2024/9/18TheFirstHospitalofXinxiangMedicalCollege5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2024/9/18TheFirstHospitalofXinxiangMedicalCollege6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)BPHBOOLUTS2024/9/18TheFirstHospitalofXinxiangMedicalCollege7国际前列腺症状评分(I-PSS)过去1个月症状无1/5<1/2约1/2>1/2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0123457.夜尿次数012345I-PSS：Score(0～35)2024/9/18TheFirstHospitalofXinxiangMedicalCollege8I-PSSMeans0-7分轻度增生8-19分中度增生20-35分重度增生2024/9/18TheFirstHospitalofXinxiangMedicalCollege9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(0～6)2024/9/18TheFirstHospitalofXinxiangMedicalCollege10诊断50岁以上男性，进行性排尿困难直肠指诊(DigitalRectalExam,DRE)触及增生前列腺Ⅰ°增生：鸡蛋大小Ⅱ°增生：鸭蛋大小Ⅲ°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2024/9/18TheFirstHospitalofXinxiangMedicalCollege11鉴别诊断膀胱颈纤维化(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2024/9/18TheFirstHospitalofXinxiangMedicalCollege12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2024/9/18TheFirstHospitalofXinxiangMedicalCollege13药物治疗α-受体阻滞剂：降低前列腺平滑肌张力非选择性α-受体阻滞剂：酚卞明选择性α1-受体阻滞剂：Hytrin(高特灵)高选择性α1a-受体阻滞剂：哈乐5α-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2024/9/18TheFirstHospitalofXinxiangMedicalCollege14手术治疗适应症：残余尿量大于50ml曾经出现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2024/9/18TheFirstHospitalofXinxiangMedicalCollege15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”(GoldStandard)2024/9/18TheFirstHospitalofXinxiangMedicalCollege162024/9/18TheFirstHospitalofXinxiangMedicalCollege172024/9/18TheFirstHospitalofXinxiangMedicalCollege18经尿道增生腺体切除术2024/9/18TheFirstHospitalofXinxiangMedicalCollege19前列腺电汽化术TUVP

TransurethralVaporizationoftheProstate

2024/9/18TheFirstHospitalofXinxiangMedicalCollege20前列腺电切除术TURP

TransurethralResectionoftheProstate

2024/9/18TheFirstHospitalofXinxiangMedicalCollege21电切除的前列腺碎片2024/9/18TheFirstHospitalofXinxiangMedicalCollege22前列腺钬激光切除术2024/9/18TheFirstHospitalofXinxiangMedicalCollege23LaserAblationoftheProstate

2024/9/18TheFirstHospitalofXinxiangMedicalCollege24前列腺两侧叶、中叶增生合并膀胱结石2024/9/18TheFirstHospitalofXinxiangMedicalCollege25TreatmentofBPHPlaceboWatchfulwaitingPharmacotherapyAlpha-blockers5alphareductaseinhibitorsPhytotherapySurgeryTURPTUVPTUIPO