三种镍钛合金支架治疗高危前列腺梗阻患者的疗效观察(附116例报告)
孙玉成 王健 李进 张弋 赵玉明摘要 目的：了解三种镍钛合金支架治疗膀胱颈梗阻的疗效和有效时间。方法：1992年3月～1999年6月应用镍钛螺旋支架治疗前列腺梗阻35例(螺旋支架组)，应用国产镍钛网状支架治疗前列腺梗阻58例(国产网架组)，应用Angiomed网状支架治疗前列腺增生23例(Angiomed网架组)。结果：螺旋支架组随访21～60个月，显效8例(22.8%)，有效24例(68.6%)，平均有效时间10.8个月；国产网架组随访24～66个月，2年有效率85.7%，3年有效率76.8%，4年有效率62.8%；Angiomed网架组随访23～64个月，2年有效率100%，3年有效率91.6%，4年有效率88.8%，平均有效时间41.4个月。结论：螺旋支架仅作为临时支架目前临床已很少应用；国产网架有足够大直径和支撑力，易嵌入尿道而被粘膜覆盖成为永久性支架，而且价格为大多数患者所接受；Angiomed网架有较高组织相容性，刺激性小，易为上皮覆盖，其疗效优于国产网架。
关键词 镍钛合金支架 前列腺梗阻 前列腺增生症
Evaluation of treatment effects of three different urethral stents in patients with prostatic obstruction (Report of 116 cases)
SUN Yu-cheng WANG Jian LI Jin ZHANG yi ZHAO Yu-ming
(Department of Urology, the Xuanwu Hospital, Capital Medical University, Beijing,100053)
Abstract Purpose: In order to know the effectiveness of three different urethral stents in the treatment of prostatic obstruction . Methods: 35 cases were treated with spiral stents (group on e) from Mar.1992 to Jun.1999,including benign prostatic hyperplasia (BPH) 34 cases, prostatic cancer 1 case, mean age 71.5years. From Oct.1993 to Jun.1999,58 cases were implanted with tubular meshes (group two), including BPH 54, advanced prostate cancer 4, mean age 76.9 years. During the same period as group tow, 23 cases with BPH were treated with Angiomed mesh (Urolume memotherm,group three), mean age was 75.1years, in which 17 received epidural anesthesia and percutanous cystostomy. Results: For group one, good results were achieved in eight cases (22.8%) and significant improvements occurred in 24 (68.5%) with a follow up of 21～60 months, mean effective time was 10.8 months. For group two, a dramatically effective rate was obtained in 54 (96%), with a follow up of 24～66 months (mean 42.6 months), two, three and four year effective rates were 85.7%, 78% and 63%. With a follow up of 23～64 months, we have got 100%, 91.6% and 88.8% of two, three and four year effective rates in group three. Conclusions: Spiral stent has poor effective rate and is rarely used an present. The tubular mesh with a diameter large enough and good antipressure properties makes it possible to be inserted into the urethral and covered by urothelium. As a permanent stent, a 78% and 63% effective rate was achieved at least three and four years after the implantation and many patients can afford the expenses. Compared with the tubular mesh, Angiomed stent wit h high compatibility with the tissue, low irritation and easy coverage by urothelium, has shown a 90% three year effective rate. The tubular mesh should be further improved in quality.
Key words Urethral stent Prostatic obstruction Benign prostatic hyperplasia
我院从1992年3月～1999年6月应用镍钛螺旋支架治疗前列腺梗阻35例(螺旋支架组)，1993年10月～1999年6月应用国产镍钛网状支架治疗前列腺梗阻58例(国产网架组)，1994年3月～1999年6月应用Angiomed网状支架(Urolume memotherm)治疗良性前列腺增生(BPH)23例(Angiomed网架组)，现将三组远期疗效和并发症进行比较，并将结果报告如下。
1 资料与方法
三组的临床资料与治疗方法按组予以报告。
螺旋支架组35例，年龄60～83岁，平均71.5岁。其中BPH 34例，前列腺癌1例。34例BPH者中，28例有尿潴留，14例长期带耻骨上造瘘管，6例排尿困难。9例并发氮质血症，8例伴严重心血管病，2例伴糖尿病。B超测得前列腺尿道长度为3.5～6.5 cm。选用直径6～7 mm和7～8 mm、长35～70 mm螺旋支架，在1%地卡因粘膜麻醉下采用联合经腹B超和膀胱镜直视下置入法进行治疗。手术时间15～55 min，平均22.5 min。
国产网架组58例，年龄55～93岁，平均76.9岁。其中BPH 54例，前列腺癌4例。54例BPH者中，尿潴留42例，长期带造瘘管17例，剩余尿量50～200 ml 6例，中转网架者4例，并发高血压、冠心病、心肌梗死13例，伴肺心病、慢性支气管炎10例，脑血管病8例，糖尿病4例，肾功能衰竭3例。B超测得前列腺尿道长度50～75 mm，其中2例分别为70和75 mm，各置入2只网架［(30+35)mm，(35+35)mm］。经膀胱镜置入8例，应用置入器置入50例。47例采用地卡因粘膜麻醉，11例采用连续硬膜外麻醉。
Angiomed网架组23例，均为BPH，平均年龄79.5岁。其中尿潴留17例，排尿困难6例。B超测得后尿道长度30～55 mm。选用网架长30～50 mm。17例在连续硬膜外麻醉下先行耻骨上膀胱穿刺造口，4例已有耻骨上造口者采用地卡因粘膜麻醉。均在直视下置入网架于膀胱内尿道口到精阜间，22例一次置入成功，1例下缘撑住部分括约肌，5 d后经调整位置正常。
2 结果
2.1 疗效评定标准
显效：美国泌尿学会(AUA)症状评分≤10分，最大尿流率＞10 ml/s，剩余尿量≤50 ml。有效：AUA评分≤18分，最大尿流率＞5 ml/s，剩余尿量＜150 ml。无效：AUA评分＞20分，最大尿流率＜5 ml/s，剩余尿量＞150 ml。
2.2 治疗效果
螺旋支架组35例中，2例置入失败；33例随访21～60个月，显效8例(22.8%)，有效24例(68.6%)，总有效率为91.4%。术后6个月内取出支架12例(附睾炎5例，移位2例，不能耐受3例，中转手术2例)，12个月取出支架6例(增生肉芽阻塞3例，移位1例，不能耐受2例)，24个月中转手术4例(网架治疗)，死于其他疾病7例，失访2例，仍带管2例。3例复查尿道膀胱镜，仅小部分螺旋支架有上皮覆盖。支架平均有效时间为10.8个月。
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