55章良性前列腺增生.ppt

2019/11/1,the first hospital of xinxiang medical college,1,良性前列腺增生 benign prostatic hyperplasia,bph,2019/11/1,the first hospital of xinxiang medical college,2,前列腺的位置,2019/11/1,the first hospital of xinxiang medical college,3,概述,bph又称为前列腺肥大(prostate enlargement) 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3540岁开始增生，50岁出现症状，60岁需要进行有效的治疗,2019/11/1,the first hospital of xinxiang medical college,4,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,2019/11/1,the first hospital of xinxiang medical college,5,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,2019/11/1,the first hospital of xinxiang medical college,6,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,2019/11/1,the first hospital of xinxiang medical college,7,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),bph,boo,luts,2019/11/1,the first hospital of xinxiang medical college,8,国际前列腺症状评分(i-pss),i-pss：score(035),2019/11/1,the first hospital of xinxiang medical college,9,i-pss means,2019/11/1,the first hospital of xinxiang medical college,10,生活质量评分,生活质量评分：l(06),2019/11/1,the first hospital of xinxiang medical college,11,诊断,50岁以上男性，进行性排尿困难 直肠指诊(digital rectal exam,dre)触及增生前列腺 增生：鸡蛋大小 增生：鸭蛋大小 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,2019/11/1,the first hospital of xinxiang medical college,12,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,2019/11/1,the first hospital of xinxiang medical college,13,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,2019/11/1,the first hospital of xinxiang medical college,14,药物治疗,-受体阻滞剂 ：降低前列腺平滑肌张力 非选择性-受体阻滞剂 ：酚卞明 选择性1-受体阻滞剂 ：hytrin(高特灵) 高选择性1a-受体阻滞剂：哈乐 5-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,2019/11/1,the first hospital of xinxiang medical college,15,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,2019/11/1,the first hospital of xinxiang medical college,16,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” (gold standard),2019/11/1,the first hospital of xinxiang medical college,17,2019/11/1,the first hospital of xinxiang medical college,18,2019/11/1,the first hospital of xinxiang medical college,19,经尿道增生腺体切除术,2019/11/1,the first hospital of xinxiang medical college,20,前列腺电汽化术tuvp transurethral vaporization of the prostate,2019/11/1,the first hospital of xinxiang medical college,21,前列腺电切除术turp transurethral resection of the prostate,2019/11/1,the first hospital of xinxiang medical college,22,电切除的前列腺碎片,2019/11/1,the first hospital of xinxiang medical college,23,前列腺钬激光切除术,2019/11/1,the first hospital of xinxiang medical college,24,laser ablation of the prostate,2019/11/1,the first hospital of xinxiang medical college,25,前列腺两侧叶、中叶增生合并膀胱结石,2019/11/1,the first hospital of xinxiang medical college,26,treatment of bph,placebo watchful waiting pharmacotherapy alpha-blockers 5alpha reductase inhibitors phytotherapy surgery turp tuvp tuip open prostatectomy,m