良性前列腺增生

1、良性前列腺增生Benign Prostatic Hyperplasia,BPH1第1頁(yè)/10/10The First Hospital of Xinxiang Medical College2前列腺位置第2頁(yè)/10/10The First Hospital of Xinxiang Medical College3概述BPH又稱為前列腺肥大(Prostate Enlargement)BPH是指腺上皮細(xì)胞增多，而非細(xì)胞肥大BPH是老年男性常見(jiàn)疾病北方地域發(fā)病率高于南方通常前列腺?gòu)?540歲開(kāi)始增生，50歲出現(xiàn)癥狀，60歲需要進(jìn)行有效治療第3頁(yè)/10/10The First Hospital of

2、Xinxiang Medical College4病因前列腺發(fā)育依賴于功效性睪丸存在“雙氫睪酮(DHT) ”學(xué)說(shuō)(70年Wilson提出) 基質(zhì)與上皮相互作用性激素與基質(zhì)-上皮間相互作用雙氫睪酮學(xué)說(shuō)示意圖第4頁(yè)/10/10The First Hospital of Xinxiang Medical College5病理通常將前列腺分為移行帶(尿道周?chē)袤w、占5%)、外周帶、中央帶增生部分主要是尿道周?chē)袤w增生腺體壓迫外周帶成為外科包膜增生結(jié)節(jié)：基質(zhì)型、腺泡型、混合型第5頁(yè)/10/10The First Hospital of Xinxiang Medical College6病理增生使前列腺段

3、尿道彎曲、伸長(zhǎng)、狹窄，造成膀胱出口（BOO）梗阻梗阻代償期：膀胱逼尿肌肥厚 梗阻失代償期：充溢性尿失禁、上尿路積水?dāng)U張、代謝產(chǎn)物潴留、尿毒癥增生程度與梗阻程度不一定成正比第6頁(yè)/10/10The First Hospital of Xinxiang Medical College7臨床表現(xiàn)尿頻：最早出現(xiàn)癥狀排尿困難：最主要癥狀尿潴留：梗阻加重表現(xiàn)其它：血尿、感染、結(jié)石、腎積水、疝、痔等(實(shí)物標(biāo)本)BPHBOOLUTS第7頁(yè)/10/10The First Hospital of Xinxiang Medical College8國(guó)際前列腺癥狀評(píng)分(I-PSS)過(guò)去1個(gè)月癥狀無(wú)1/51/2總是1.

4、尿不盡感0123452.間隔2h0123453.間斷排尿0123454.憋尿困難0123455.尿線變細(xì)0123456.排尿費(fèi)勁0123457.夜尿次數(shù)012345I-PSS：Score(035)第8頁(yè)/10/10The First Hospital of Xinxiang Medical College9I-PSS Means 0-7 分輕度增生8-19 分中度增生20-35 分重度增生第9頁(yè)/10/10The First Hospital of Xinxiang Medical College10生活質(zhì)量評(píng)分患者認(rèn)為其現(xiàn)在排尿情況非常好好滿意半數(shù)滿意多數(shù)不滿不滿意很痛苦評(píng)分0123456生

5、活質(zhì)量評(píng)分：L(06)第10頁(yè)/10/10The First Hospital of Xinxiang Medical College11診療50歲以上男性，進(jìn)行性排尿困難直腸指診(Digital Rectal Exam,DRE)觸及增生前列腺增生：雞蛋大小 增生：鴨蛋大小 增生：鵝蛋大小客觀指標(biāo)：殘余尿、尿流率、PSA測(cè)定膀胱鏡檢或B超檢驗(yàn)：直接測(cè)定前列腺大小第11頁(yè)/10/10The First Hospital of Xinxiang Medical College12判別診療膀胱頸纖維化(膀胱頸攣縮)：慢性炎癥所致，發(fā)病年紀(jì)較輕前列腺癌：前列腺堅(jiān)硬，表面不平，PSA膀胱癌：指膀胱頸附近

6、膀胱癌，膀胱鏡檢能夠判別神經(jīng)原性膀胱尿道功效障礙：有神經(jīng)系統(tǒng)損害病史和體征尿道狹窄：有尿道損傷、感染病史第12頁(yè)/10/10The First Hospital of Xinxiang Medical College13治療目標(biāo)：緩解增生腺體所致膀胱出口梗阻膀胱出口梗阻(BOO)原因：增生腺體擠壓尿道所致機(jī)械性梗阻增生腺體平滑肌張力所致動(dòng)力性梗阻治療方法：很多第13頁(yè)/10/10The First Hospital of Xinxiang Medical College14藥品治療-受體阻滯劑 ：降低前列腺平滑肌張力非選擇性-受體阻滯劑 ：酚卞明選擇性1-受體阻滯劑 ：Hytrin(高特靈)高

7、選擇性1a-受體阻滯劑：哈樂(lè)5-還原酶抑制劑：Proscar(保列治)阻止睪酮轉(zhuǎn)變?yōu)镈HT，長(zhǎng)久服用可使前列腺體積縮小花粉類制劑：舍尼通 等第14頁(yè)/10/10The First Hospital of Xinxiang Medical College15手術(shù)治療適應(yīng)癥：殘余尿量大于50ml 曾經(jīng)出現(xiàn)過(guò)急性尿潴留大量出血或重復(fù)肉眼血尿病人迫切要求，身體情況能耐受手術(shù)手術(shù)方法：恥骨上前列腺增生腺體摘除術(shù) 恥骨后摘除術(shù) 經(jīng)會(huì)陰摘除術(shù) 經(jīng)尿道前列腺電切或電汽化術(shù)第15頁(yè)/10/10The First Hospital of Xinxiang Medical College16經(jīng)尿道增生腺體切除術(shù)當(dāng)前

8、，在全世界范圍內(nèi)，這種治療方法被公認(rèn)為治療BPH“金標(biāo)準(zhǔn)”(Gold Standard)第16頁(yè)/10/10The First Hospital of Xinxiang Medical College17第17頁(yè)/10/10The First Hospital of Xinxiang Medical College18第18頁(yè)/10/10The First Hospital of Xinxiang Medical College19經(jīng)尿道增生腺體切除術(shù)第19頁(yè)/10/10The First Hospital of Xinxiang Medical College20前列腺電汽化術(shù)TUVPTra

9、nsurethral Vaporization of the Prostate 第20頁(yè)/10/10The First Hospital of Xinxiang Medical College21前列腺電切除術(shù)TURPTransurethral Resection of the Prostate 第21頁(yè)/10/10The First Hospital of Xinxiang Medical College22電切除前列腺碎片第22頁(yè)/10/10The First Hospital of Xinxiang Medical College23前列腺鈥激光切除術(shù)第23頁(yè)/10/10The Firs

10、t Hospital of Xinxiang Medical College24Laser Ablation of the Prostate 第24頁(yè)/10/10The First Hospital of Xinxiang Medical College25前列腺兩側(cè)葉、中葉增生合并膀胱結(jié)石第25頁(yè)/10/10The First Hospital of Xinxiang Medical College26Treatment of BPHPlaceboWatchful waitingPharmacotherapyAlpha-blockers5alpha reductase inhibitorsPhytotherapySurgeryTURP TUVP TUIPOpen prostatectomyMini