良性前列腺增生

1、良性前列腺增生Benign Prostatic Hyperplasia,BPH1第1页/10/10The First Hospital of Xinxiang Medical College2前列腺位置第2页/10/10The First Hospital of Xinxiang Medical College3概述BPH又称为前列腺肥大(Prostate Enlargement)BPH是指腺上皮细胞增多，而非细胞肥大BPH是老年男性常见疾病北方地域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岁需要进行有效治疗第3页/10/10The First Hospital of

2、Xinxiang Medical College4病因前列腺发育依赖于功效性睾丸存在“双氢睾酮(DHT) ”学说(70年Wilson提出) 基质与上皮相互作用性激素与基质-上皮间相互作用双氢睾酮学说示意图第4页/10/10The First Hospital of Xinxiang Medical College5病理通常将前列腺分为移行带(尿道周围腺体、占5%)、外周带、中央带增生部分主要是尿道周围腺体增生腺体压迫外周带成为外科包膜增生结节：基质型、腺泡型、混合型第5页/10/10The First Hospital of Xinxiang Medical College6病理增生使前列腺段

3、尿道弯曲、伸长、狭窄，造成膀胱出口（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、尿毒症增生程度与梗阻程度不一定成正比第6页/10/10The First Hospital of Xinxiang Medical College7临床表现尿频：最早出现症状排尿困难：最主要症状尿潴留：梗阻加重表现其它：血尿、感染、结石、肾积水、疝、痔等(实物标本)BPHBOOLUTS第7页/10/10The First Hospital of Xinxiang Medical College8国际前列腺症状评分(I-PSS)过去1个月症状无1/51/2总是1.

4、尿不尽感0123452.间隔2h0123453.间断排尿0123454.憋尿困难0123455.尿线变细0123456.排尿费劲0123457.夜尿次数012345I-PSS：Score(035)第8页/10/10The First Hospital of Xinxiang Medical College9I-PSS Means 0-7 分轻度增生8-19 分中度增生20-35 分重度增生第9页/10/10The First Hospital of Xinxiang Medical College10生活质量评分患者认为其现在排尿情况非常好好满意半数满意多数不满不满意很痛苦评分0123456生

5、活质量评分：L(06)第10页/10/10The First Hospital of Xinxiang Medical College11诊疗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超检验：直接测定前列腺大小第11页/10/10The First Hospital of Xinxiang Medical College12判别诊疗膀胱颈纤维化(膀胱颈挛缩)：慢性炎症所致，发病年纪较轻前列腺癌：前列腺坚硬，表面不平，PSA膀胱癌：指膀胱颈附近

6、膀胱癌，膀胱镜检能够判别神经原性膀胱尿道功效障碍：有神经系统损害病史和体征尿道狭窄：有尿道损伤、感染病史第12页/10/10The First Hospital of Xinxiang Medical College13治疗目标：缓解增生腺体所致膀胱出口梗阻膀胱出口梗阻(BOO)原因：增生腺体挤压尿道所致机械性梗阻增生腺体平滑肌张力所致动力性梗阻治疗方法：很多第13页/10/10The First Hospital of Xinxiang Medical College14药品治疗-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

7、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，长久服用可使前列腺体积缩小花粉类制剂：舍尼通 等第14页/10/10The First Hospital of Xinxiang Medical College15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重复肉眼血尿病人迫切要求，身体情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第15页/10/10The First Hospital of Xinxiang Medical College16经尿道增生腺体切除术当前

8、，在全世界范围内，这种治疗方法被公认为治疗BPH“金标准”(Gold Standard)第16页/10/10The First Hospital of Xinxiang Medical College17第17页/10/10The First Hospital of Xinxiang Medical College18第18页/10/10The First Hospital of Xinxiang Medical College19经尿道增生腺体切除术第19页/10/10The First Hospital of Xinxiang Medical College20前列腺电汽化术TUVPTra

9、nsurethral Vaporization of the Prostate 第20页/10/10The First Hospital of Xinxiang Medical College21前列腺电切除术TURPTransurethral Resection of the Prostate 第21页/10/10The First Hospital of Xinxiang Medical College22电切除前列腺碎片第22页/10/10The First Hospital of Xinxiang Medical College23前列腺钬激光切除术第23页/10/10The Firs

10、t Hospital of Xinxiang Medical College24Laser Ablation of the Prostate 第24页/10/10The First Hospital of Xinxiang Medical College25前列腺两侧叶、中叶增生合并膀胱结石第25页/10/10The First Hospital of Xinxiang Medical College26Treatment of BPHPlaceboWatchful waitingPharmacotherapyAlpha-blockers5alpha reductase inhibitorsPhytotherapySurgeryTURP TUVP TUIPOpen prostatectomyMini