2025/8/1TheFirstHospitalofXinxiangMedicalCollege1良性前列腺增生

BenignProstaticHyperplasia,BPH2025/8/1TheFirstHospitalofXinxiangMedicalCollege2前列腺的位置2025/8/1TheFirstHospitalofXinxiangMedicalCollege3概述BPH又稱(chēng)為前列腺肥大(ProstateEnlargement)BPH是指腺上皮細(xì)胞的增多，而非細(xì)胞的肥大BPH是老年男性常見(jiàn)疾病北方地區(qū)的發(fā)病率高于南方通常前列腺?gòu)?5～40歲開(kāi)始增生，50歲出現(xiàn)病癥，60歲需要進(jìn)行有效的治療2025/8/1TheFirstHospitalofXinxiangMedicalCollege4病因前列腺發(fā)育依賴(lài)于功能性睪丸的存在“雙氫睪酮(DHT)〞學(xué)說(shuō)(70年Wilson提出)基質(zhì)與上皮的相互作用性激素與基質(zhì)-上皮間的相互作用雙氫睪酮學(xué)說(shuō)示意圖2025/8/1TheFirstHospitalofXinxiangMedicalCollege5病理通常將前列腺分為移行帶(尿道周?chē)袤w、占5%)、外周帶、中央帶增生的局部主要是尿道周?chē)袤w增生的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2025/8/1TheFirstHospitalofXinxiangMedicalCollege6病理增生使前列腺段尿道彎曲、伸長(zhǎng)、狹窄，導(dǎo)致膀胱出口〔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、尿毒癥增生的程度與梗阻程度不一定成正比2025/8/1TheFirstHospitalofXinxiangMedicalCollege7臨床表現(xiàn)尿頻：最早出現(xiàn)的病癥排尿困難：最重要的病癥尿潴留：梗阻加重的表現(xiàn)其他：血尿、感染、結(jié)石、腎積水、疝、痔等(實(shí)物標(biāo)本)BPHBOOLUTS2025/8/1TheFirstHospitalofXinxiangMedicalCollege8國(guó)際前列腺病癥評(píng)分(I-PSS)過(guò)去1個(gè)月癥狀無(wú)1/5<1/2約1/2>1/2總是1.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)力0123457.夜尿次數(shù)012345I-PSS：Score(0～35)2025/8/1TheFirstHospitalofXinxiangMedicalCollege9I-PSSMeans0-7分輕度增生8-19分中度增生20-35分重度增生2025/8/1TheFirstHospitalofXinxiangMedicalCollege10生活質(zhì)量評(píng)分患者認(rèn)為其現(xiàn)在的排尿狀況非常好好滿(mǎn)意半數(shù)滿(mǎn)意多數(shù)不滿(mǎn)不滿(mǎn)意很痛苦評(píng)分0123456生活質(zhì)量評(píng)分：L(0～6)2025/8/1TheFirstHospitalofXinxiangMedicalCollege11診斷50歲以上男性，進(jìn)行性排尿困難直腸指診(DigitalRectalExam,DRE)觸及增生前列腺Ⅰ°增生：雞蛋大?、颉阍錾壶喌按笮、蟆阍錾葫Z蛋大小客觀指標(biāo)：剩余尿、尿流率、PSA測(cè)定膀胱鏡檢或B超檢查：直接測(cè)定前列腺大小2025/8/1TheFirstHospitalofXinxiangMedicalCollege12鑒別診斷膀胱頸纖維化(膀胱頸攣縮)：慢性炎癥所致，發(fā)病年齡較輕前列腺癌：前列腺堅(jiān)硬，外表不平，PSA膀胱癌：指膀胱頸附近的膀胱癌，膀胱鏡檢可以鑒別神經(jīng)原性膀胱尿道功能障礙：有神經(jīng)系統(tǒng)損害的病史和體征尿道狹窄：有尿道損傷、感染病史2025/8/1TheFirstHospitalofXinxiangMedicalCollege13治療目的：緩解增生腺體所致的膀胱出口梗阻膀胱出口梗阻(BOO)的原因：增生腺體擠壓尿道所致的機(jī)械性梗阻增生腺體平滑肌張力所致的動(dòng)力性梗阻治療方法：很多2025/8/1TheFirstHospitalofXinxiangMedicalCollege14藥物治療α-受體阻滯劑：降低前列腺平滑肌張力非選擇性α-受體阻滯劑：酚卞明選擇性α1-受體阻滯劑：Hytrin(高特靈)高選擇性α1a-受體阻滯劑：哈樂(lè)5α-復(fù)原酶抑制劑：Proscar(保列治)—阻止睪酮轉(zhuǎn)變?yōu)镈HT，長(zhǎng)期服用可使前列腺體積縮小花粉類(lèi)制劑：舍尼通等2025/8/1TheFirstHospitalofXinxiangMedicalCollege152025/8/1TheFirstHospitalofXinxiangMedicalCollege16目前，在全世界范圍內(nèi)，這種治療方法被公認(rèn)為治療BPH的“金標(biāo)準(zhǔn)〞(GoldStandard)2025/8/1TheFirstHospitalofXinxiangMedicalCollege172025/8/1TheFirstHospitalofXinxiangMedicalCollege182025/8/1TheFirstHospitalofXinxiangMedicalCollege192025/8/1TheFirstHospitalofXinxiangMedicalCollege202025/8/1TheFirstHospitalofXinxiangMedicalCollege212025/8/1TheFirstHospitalofXinxiangMedicalCollege22電切除的前列腺碎片2025/8/1TheFirstHospitalofXinxiangMedicalCollege232025/8/1TheFirstHospitalofXinxiangMedicalCollege24LaserAblationoftheProstate

2025/8/1TheFirstHospitalofXinxiangMedicalCollege25前列腺兩側(cè)葉、中葉增生合并膀胱結(jié)石2025/8/1TheFirstHospitalofXinxiangMedicalCollege26TreatmentofBPHPlaceboWatchfulwaitingPharmacotherapyAlpha-blockers5alphareductaseinhibitorsPhytotherapySurgeryTURPTUVPTUIPOpenprostatecto