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1、2023/3/17,The First Hospital of Xinxiang Medical College,1,良性前列腺增生Benign Prostatic Hyperplasia,BPH,2023/3/17,The First Hospital of Xinxiang Medical College,2,前列腺的位置,2023/3/17,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
2、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,2023/3/17,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,2023/3/17,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
3、为外科包膜增生结节：基质型、腺泡型、混合型,2023/3/17,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,2023/3/17,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)
4、,BPH,BOO,LUTS,2023/3/17,The First Hospital of Xinxiang Medical College,8,国际前列腺症状评分(I-PSS),I-PSS：Score(035),2023/3/17,The First Hospital of Xinxiang Medical College,9,I-PSS Means,2023/3/17,The First Hospital of Xinxiang Medical College,10,生活质量评分,生活质量评分：L(06),2023/3/17,The First Hospital of Xinxiang M
5、edical 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,2023/3/17,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
6、道损伤、感染病史,2023/3/17,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,2023/3/17,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)
7、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,2023/3/17,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,2023/3/17,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“
8、金标准”(Gold Standard),2023/3/17,The First Hospital of Xinxiang Medical College,17,2023/3/17,The First Hospital of Xinxiang Medical College,18,2023/3/17,The First Hospital of Xinxiang Medical College,19,经尿道增生腺体切除术,2023/3/17,The First Hospital of Xinxiang Medical College,20,前列腺电汽化术TUVPTransurethral Vapo
9、rization of the Prostate,2023/3/17,The First Hospital of Xinxiang Medical College,21,前列腺电切除术TURPTransurethral Resection of the Prostate,2023/3/17,The First Hospital of Xinxiang Medical College,22,电切除的前列腺碎片,2023/3/17,The First Hospital of Xinxiang Medical College,23,前列腺钬激光切除术,2023/3/17,The First Hosp
10、ital of Xinxiang Medical College,24,Laser Ablation of the Prostate,2023/3/17,The First Hospital of Xinxiang Medical College,25,前列腺两侧叶、中叶增生合并膀胱结石,2023/3/17,The First Hospital of Xinxiang Medical College,26,Treatment of BPH,PlaceboWatchful waitingPharmacotherapyAlpha-blockers5alpha reductase inhibitorsPhytotherapySurgeryTURP TUVP TUIPOpen prostatectomy,Minimally Invasive TherapyHyperthermia and thermotherapy(TUMT)Transurethral Needle Ablation of prostate(TUNA)Laser CoagulationBalloon dilation,祝大家学习进步2023年3月,
