良好前列腺肥大症手術結果之預測因子

Predictive Factors for Successful Operative Outcome of Benign Prostatic Hypertrophy

郭漢崇(Hann-Chorng Kuo) ； 許悌(Tsi Hsu) ； 張世忠(Shih-Chung Chang)

《慈濟醫學雜誌》 2卷5期 (1990/09) Pp. 368-381

https://doi.org/10.6440/TZUCMJ.199009.0368

摘要

前列腺肥大症手術是泌尿科最主要的手術之一，每年全台灣有上萬病人接受手術治療以解除其排尿障礙。如何仔細選擇病人以求得到最好的手術結果一直是泌尿科醫師努力的目標。本研究收集了近兩年來在慈濟綜合醫院接受前列腺手術的247名病患，分析其臨床診斷資料以及手術後的結果，整理出良好手術結果之預測因子為：（1）急性尿瀦留，（2）嚴重排尿因難及有多量殘尿，（3）尿流速低於10ml／sec且尿流圖呈現平台型，（4）前列腺較大且切除重量大於10gm，（5）膀胱壓力圖有逼尿肌不穩定且排尿壓力大於50cmH2O，（6）經直腸超音波顯示前列腺內有大量腺瘤存在。至於不良手術結果之預測因子為：（1）病人只有膀胱刺激症狀在無尿道阻塞症狀，（2）尿流速大於10ml／sec且尿流圖為間歇型，（3）前列腺較小且切除重量小於10gm，（4）前列腺超音波無明顯腺瘤存在，（5）尿道壓力圖並未顯示高前列腺壓力區，（6）膀胱壓力圖無法激發起排尿收縮壓力，（7）慢性尿瀦留且病人對漲尿感不明顯，（8）排尿後無殘尿。相信這些預測因子可以提供泌尿科醫師在處理病人時的參考，以期減少失敗的前列腺手術。

關鍵字

前列腺肥大症 ； 經尿道前列腺切除術 ； 尿路動態機能檢查

並列摘要

Surgery for benign prostatic hypertrophy is one of the major operations in Urology. The suecessful rate of the operation is around 80 percents, which is not satisfactory for an elective surgery. The reasons account for the low successful rate are failure to demonstrate prostatic obstruction and multi-factors of voiding dysfunction. How to search for some perdictive factors that may increase the suc-cessful rate of prostatic surgery is crucial.
Two hundreds and forty-seven patients undergoing surgeries for their prostatic hypertrophy and voiding dysfunctions in recent two years are enrolled in study. There were two perioperative mortality (0.8%). Twenty-one patients had symptoms exacerbated or severe sequales (8.5%), 20 had no remarkable improvements after operation (8.2%) while 204 were successful (83.3%) in the remaining 245 patients.
The factors for a successful prostatic surgery are: (1) acute urinary retention, (2) a bigger prostate with more than 10gm resected, (3) a prominent adenoma demonstrated in transrectal ultrasonography of the prostate, (4) a maximal flow rate less than 10ml/sec, (5) the flow pattern is plateau-type or obstructive type, (6) cystometrogram shows detrusor instability and/or a high voiding pressure, (7) a high prostatic pressure area ≥ 70 cmcm H2O in urethral pressure profilometry. Factors opposite the above items, of course, may account for a failed operation.

並列關鍵字

benign prostatic hypertrophy ； transurethral resection of the prostate ； urodynamic study