【摘要】 目的 評價非那雄胺對良性前列腺增生（benign prostate hyperplasia，BPH）細胞外基質（extracellular matrixc，ECM）的影響，并探討其作用機制。 方法 2008年6月－2009年3月選擇具備手術指征的BPH患者20例，按入院順序隨機分為非那雄胺組和安慰劑組。服藥4周后，行經尿道前列腺切除術（transurethral resection prostate，TURP），留取組織標本。另取正常前列腺標本6例，用免疫組織化學法結合圖像分析系統研究正常組、安慰劑組和非那雄胺組前列腺組織纖維連接蛋白（FN）、膠原（CL）、基質金屬蛋白酶2（MMP-2）、金屬蛋白酶組織抑制因子2（TIMP-2）的陽性表達。 結果 安慰劑組前列腺組織的FN、CL的陽性表達較正常組增強（Plt;0.01），MMP-2/TIMP-2差異無統計學意義（Pgt;0.05）；非那雄胺組與安慰劑組相比，FN、CL的陽性表達減弱（Plt;0.01），而MMP-2/TIMP-2增高（Plt;0.01）。 結論 非那雄胺能降低BPH組織ECM成分，避免其沉積，其作用機制可能與其促進ECM降解有關。【Abstract】 Objective To evaluate influence of finasteride on extracellular matrix (ECM) in benign prostate hyperplasia (BPH) patients and study the mechanism. Methods Twenty BPH patients needing surgery were randomly divided into 2 groups according to the sequence of hospitalization from June 2008 to March 2009. The finasteride group and the placebo group had 10 patients each. Transurethral resection prostate (TURP) were performed and the specimens were collected after 4 weeks of drug administration. Moreover, 6 normal prostatic tissues were selected. Expressions of fibronectin (FN), collagen (CL), matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-2 (TIMP-2) were studied in prostatic tissues in all groups (including the normal group) by immunohistochemistry and image analysis system. Results Expressions of FN and CL were significantly higher than those in the normal group (Plt;0.01), while expressions of MMP-2 and TIMP-2 were not significantly different between them (Pgt;0.05). Compared with the placebo group, expressions of FN and CL in the finateride group were significantly lower than the placebo group (Plt;0.01), while expressions of MMP-2 and TIMP-2 were significantly higher (Plt;0.01). Conclusions BPH is related to ECM depositing. Finasteride can decrease ECM of BPH and refrain it from depositing. Possibly, the principle is that finasteride can promote the degradation of ECM.
摘要:目的:探討良性前列腺增生經尿道前列腺電切術圍手術期的護理經驗。方法:回顧性分析96例良性前列腺增生患者臨床資料。結果:96例患者手術順利,圍手術期經周密的護理,療效滿意,無明顯并發癥。結論:周密的手術期護理對經尿道前列腺電切術治療老年良性前列腺增生十分重要。Abstract: Objective: To investigate the perioperative nursing care of transurethral prostatic resection (TURP). Methods: The data of 96 TURP cases were analyzed retrospectively. Results: All the operations were performed successfully, and there were no obvious complications among the patients with precise nursing care. Conclusion: It is very important for precise nursing care to the patients who underwent TURP.
目的:探討微創治療BPH并發膀胱結石的方法。方法:應用氣壓彈道碎石術聯合TURP治療BPH并發膀胱結石26例。結果:24例一次成功,1例一期碎石,二期行TURP;1例中轉開放手術。結論:氣壓彈道碎石術聯合TURP治療BPH并發膀胱結石創傷小,恢復快,安全高效。
Prostate disease is one of the most common urological disease. A large number of studies have shown that prostate disease is related to changes in the local microenvironment. Periodontitis is a chronic inflammatory disease characterized by the destruction of periodontal tissue caused by a variety of pathogenic microorganisms. Its pathogenesis may involve many factors. Periodontitis may have adverse effects on cardiovascular, respiratory, digestive and endocrine systems. Recent studies have found that chronic periodontitis is associated with the occurrence and development of benign prostatic hyperplasia and prostatitis, but the relationship is not clear. Therefore, further research is needed. This article elaborates on inflammation and benign prostatic hyperplasia and prostatitis, periodontitis and prostatitis, and periodontitis and benign prostatic hyperplasia, aiming to provide certain ideas for clinical research and diagnosis and treatment.
Objective To evaluate the effectiveness of terazosin, tamsulosin and finasteride for benign prostatic hyperplasia (BPH). Methods We searched the related original studies all over the world, and only included randomized controlled trials (RCT) and quasi-randomized controlled trials (CCT). MEDLINE (1966 to Dec. 2004), EMBASE (1984 to Dec. 2004), The Cochrane Library (Issue 4, 2004) and four Chinese databases were electronically searched and 10 related journals were handsearched. The studies included in the references of eligible studies were additionally searched. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross-checking. Divergences of opinion were consulted by a third party. Meta-analysis was performed by using RevMan 4.2 software. Results Twelve original studies involving 2 471 participants met inclusion criteria. Compared with terazosin, tamsulosin could improve international prostatic symptom score, with WMD 0.75, 95% confidence interval (CI) 0.03 to 1.46, P=0.04. There was no statistical difference between terazosin and tamsulosin in improving the average rate of urine flow (WMD 0.23, 95%CI -0.39 to 0.85, P=0.46), the residual urine volume (WMD 0.82, 95%CI -2.92 to 4.57, P=0.67) and in diminishing the volume of prostate (WMD 2.20, 95%CI -3.99 to 8.39, P=0.49). There was no statistical difference between finasteride and tamsulosin in improving the international prostatic symptom score (WMD 0.65, 95%CI -0.45 to 1.75, P=0.25) or the max rate of urine flow (WMD 0.39, 95%CI -0.72 to 1.51, P=0.49). Only two studies compared finasteride with terazosin and had different conclusions. Only one study compared finasteride or terazosin with a combination of these drugs suggested that the combination had higher effective power than finasteride alone but no difference with terazosin alone. Conclusions Although the effectiveness in some aspects is higher in the tamsulosin group, there is not enough evidence to show which one is the best among these three drugs. The combination of finasteride and terazosin does not show more effectiveness than terazosin alone. This review suggests that tamsulosin alone should be used for the treatment of BPH and the combination needs to be identified by better evidence. It is important to improve the quality of original studies.
目的:探討經尿道前列腺電切術(TURP)治療高危良性前列腺增生癥(BPH)的術中、術后常見并發癥的原因、預防及治療,提高手術安全性和有效性。方法: 回顧性分析62例高齡合并心肺疾患的前列腺增生癥患者行經尿道前列腺電切術(TURP)的臨床資料。結果: 62例排尿困難癥狀均改善,其中1例出現暫時性尿失禁,2月后好轉,尿路感染7例,消炎治療后好轉,5例出現肉眼血尿,做對癥處理后血尿消失,無輸血病例,無經尿道電切綜合征(TURS)發生。結論:采用TURP是良性前列腺增生癥安全有效的外科治療方法,療效滿意,并發癥少,安全性高,住院時間短,費用低。
【摘要】 目的 探討采用不同方法經尿道前列腺等離子雙極電切術（plasmakinetic resection of prostate，PKRP）的方法及療效。 方法 2008年7月-2009年12月，應用不同方法行PKRP治療156例前列腺增生。患者年齡59~87歲，平均74歲。病程20 d~18年。前列腺重量22~100 g，平均38 g。采用單純順行電切法治療38例，部分剜除分割切除法治療76例，完全剜除法治療42例。 結果 156例手術均獲成功，手術時間平均90 min。獲得前列腺組織12~87 g，平均35 g。術后留置導尿管平均5.5 d，住院時間平均6.5 d。術后組織病理學診斷為良性前列腺增生152例，前列腺癌4例。拔除尿管后均能自主排尿，部分患者術后有尿道刺激癥狀；術后1個月內出現尿道外口狹窄3例，經尿道擴張治愈。隨訪時間1~12個月，平均6個月。短期尿失禁3例，時間分別為1周、1個月及3個月；無長期尿失禁。術后3個月國際前列腺癥狀評分（IPSS）癥狀評分平均減少24分，生活質量評分平均減少3分。 結論 PKRP安全、有效、并發癥少，可針對患者情況采用不同切割方法，效果更佳。【Abstract】 Objective To explore the effects and methods of transurethral plasmakinetic resection of prostate(PKRP). Methods A total of 156 patients with prostatic hyperplasia were treated with various methods of transurethral PKRP from July 2008 to December 2009. Patient’s age ranged from 59 to 87 years,74 years on average. The disease duration was 20 days to 18 years.Method one:anterograde resection in 38 patients; method two:partition retrograde enucleation in 76 patients; method three:completely retrograde enucleation in 42 patients. Results All of the swgeries were successful. The mean duration of the operation was 90 minutes.The collected prostatic specimens were 12-87 g,35 g on average. The mean catheter remaining dwation was 5.5 days.The mean postoperative hospital stay was 6.5 days. Conclusions PKRP is safe and effective. It is effective with various methods of transurethral plasmakinetic resection of prostate.
ObjectiveTo systematically evaluate the efficacy and safety of simultaneous transurethral resection of bladder cancer and prostate (TURBT+TURP) in the treatment of bladder cancer with benign prostatic hyperplasia (BPH). MethodsWe searched PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, WanFang Data and VIP from inception to January 2015, to collect randomized controlled trials (RCTs) and cohort studies investigating the efficacy and safety of TURBT with TURP in the treatment of bladder cancer with BPH. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies, and then meta-analysis was performed using RevMan 5.3 software. Results3 A total of 3 RCTs (n=137) and 10 retrospective cohort studies (n=998) were included. The results of meta-analysis showed that there were no significant differences between the simultaneous resection group and the control group in the overall recurrence rate (RCT:OR=0.55, 95% CI:0.24 to 1.24, P=0.15; retrospective cohort study:OR=0.78, 95% CI:0.60 to 1.01, P=0.06), postoperative recurrence rate in the prostatic fossa/urethra (RCT:OR=1.40, 95% CI:0.28 to 7.60, P=0.68; retrospective cohort study:OR=1.36, 95% CI:0.49 to 3.74, P=0.55), progression rate (OR=0.93, 95% CI:0.53 to 1.61, P=0.79) and overall perioperative complication rate (RCT:OR=0.35, 95% CI:0.08 to 1.55, P=0.17; retrospective cohort study:OR=0.1.75, 95% CI:0.44 to 6.98, P=0.43). ConclusionCompared with only TURBT or sequential TURBT and TURP, simultaneous TURBT and TURP do not increase the overall recurrence rate, postoperative recurrence rate in the prostatic fossa/urethra, progression rate and overall postoperative complication rate. However, due to the limited quality and quantity of included studies, larger sample size and higher quality RCTs are needed to verify the above conclusion.
目的:探討基層醫院前列腺增生并膀胱結石的微創治療方法。方法:聯合經尿道等離子雙極電切與恥骨上小切口治41例前列腺增生癥并膀胱結石。結果:手術時間40~110min, 平均55min,術后3d拔造瘺管, 第5~6天拔除尿管,排尿通暢, 無電切綜合征(TURS)、大出血等并發癥,住院時間7±1.5天。數字疼痛評分0~6,平均3.5。結論：等離子體雙極電切結合恥骨上小切口是治療前列腺增生并膀胱結石的一種快速、安全有效、微創的手術方法,值得在基層醫院推廣。