探討良性攝護腺增生症病患在接受手術治療的結果與身體健康相關的生活品質

研究目的：隨著高齡化社會的來臨，老年人的健康議題愈來愈受到重視。攝護腺肥大(BPH)好發於50歲以上的男性，隨著年齡的增加，接受攝護腺手術的機會也越高。現今國內研究著重於不同的治療方式對病患的影響，但對於因排尿症狀困擾而接受手術後，實際上的生活品質是否獲得改善則鮮少有相關報告。研究方法：本研究採前瞻性研究設計，在2012年6月至2013年2月期間，收集二間醫院（醫學中心及區域醫院）在這段期間確定診斷為BPH合併有下尿路症狀的患者，排除8人為癌症，最後收案人數有97人，其中TURP組有71人，PVP組有26人，在手術前、手術後一個月及手術後三個月不同時間點，使用具有信度的SF-36及IPSS問卷進行資料蒐集，進行健康相關生活品質及排尿症狀之研究。研究結果：本研究中，PVP組和TURP組在術後結果方面：住院天數、重置導尿管、尿後餘尿量、最大尿流速、IPSS、IPSS-Qol、SF-36，兩組無顯著性差異；在手術時間、術後尿道疼痛、留置導尿管天數，兩組達顯著性差異，P值<0.001，PVP組有較少出血情形、術後疼痛少、再手術及早期併發症少，TURP組的手術時間較PVP短。重返急診或再住院及再次手術在TURP組則有較高發生率的情形。在手術後一個月及手術後三個月，TURP組與PVP組在IPSS均有大幅度改善，在手術後三個月比手術前平均減少17分，IPSS-Qol也比手術前平均減少約4分，兩組在術後不同時間點皆無顯著性差異。以SF-36健康相關生活品質量表，在TURP與PVP兩組在術後不同時間點作比較，手術後分數都高於手術前的分數，但兩組間並無顯著性差異。根據GEE分析預測其影響因子，在年齡、合併有高血壓、手術前有腎水腫，SF-36構面PF、VT、RE、RP、MH分數會減少；反之BPH病患合併有心臟病、急性尿滯留、手術後攝護腺體積變小，在RP、GH、SF、RE、MH構面分數增加，顯示BPH病患接受攝護腺手術，排尿症狀及生活品質均會獲得改善。結論與建議：本研究發現BPH病患接受手術後在排尿症狀及生活品質方面，二種手術之效果並無顯著性差異，生活品質於術後都有改善的狀況。對於年紀較大的男性BPH病患通常也合併有其他內科疾病，因此手術時都必須考量其共病症，才能減少併發症的發生。

關鍵字

良性攝護腺增生症；下尿路症狀；經尿道前列腺刮除手術；攝護腺雷射汽化手術；國際攝護腺症狀評分表

並列摘要

Objective: The advent of an aging society, health issues of the elderly are getting more and more important. Benign prostate hyperplasia (BPH) occurs in aging men over the age of 50, and about 70% of men aged over 70 years has enlarged prostate. The incidence of prostate surgery is getting higher as the patients are getting older. Today, the domestic studies focuse on the impact of the effects of different treatment on the BPH patients. However, there is few report evaluates the short-term quality of life improvement after prostate surgery for voiding symptom distress. Measures: This prospective study collected men aged over 50 years from two hospitals with a diagnosis of BPH and low urinary tract symptoms (LUTS) from June 2012 to February 2013. A total of 97 patients received prostate surgery. Among them, 71 patients treated by transurethral resection of prostate (TURP) and 26 patients received photoselective vaporization of prostate (PVP). Assessments were conducted before the surgery, one month and three months after the surgery. The surgical outcomes, international prostate symptom score (IPSS), and short form(SF-36) of quality of life(QoL) scores were assessed. Result: The present results showed there are no significant differences between the TURP group and PVP group in hospital stay, reset of urinary catheter, post-void residual urine, maximal urine flow rate, IPSS, QoL, and SF-36. However, as for the operative time, post-operative urethral pain, and indwelling catheter days, there is significant difference between two groups (p <0.001). There were fewer blood loss, less urethral pain, less complications and less early reoperation rate in PVP group. However, there is shorter operative time in TURP group. There is also higher inidence of re- hospitalization and re-operation in the TURP group. At the 1 and 3 months following surgery, both groups had significant improvement in IPSS. The IPSS decreased by 17 points and QoL decreased by 4 points following 3 months of surgery. There were no significant difference between these two groups at different time points after the surgery. As for SF-36, post-operative scores are higher than pre-operative scores at different time points following surgery, but there was no significant difference between different surgical groups.According to The GEE analysis prediction, age, hypertension, and hydronephrosis decreased the PF, VT, RE, RP, MH subscores in SF-36. Nevertheless, the RP, GH, SF, RE, MH subscores in SF-36 increased when BPH patients are comorbid with heart disease, acute urinary retention, and smaller prostate size. These results showed prostate surgery for BPH patients improved their urinary symptoms and quality of life. Conclusion and suggest: The present study demonstrates there is no significant difference in voiding symptoms relief and quality of life improvement between these two surgeries for BPH patients. The surgery of BPH improvement the QoL for patients after surgery. For older BPH patients comorbid with other medical conditions, we should be careful before performing surgery to avoid post-operative complications.