55章良性前列腺增生课件.ppt

1、2022-7-5The First Hospital of Xinxiang Medical College1良性前列腺增生Benign Prostatic Hyperplasia,BPH2022-7-5The First Hospital of Xinxiang Medical College2前列腺的位置2022-7-5The First Hospital of Xinxiang Medical College3概述uBPH又称为前列腺肥大(Prostate Enlargement)uBPH是指腺上皮细胞的增多，而非细胞的肥大uBPH是老年男性常见疾病u北方地区的发病率高于南方u通常前列腺

2、从3540岁开始增生，50岁出现症状，60岁需要进行有效的治疗2022-7-5The First Hospital of Xinxiang Medical College4病因u前列腺发育依赖于的存在u“ ”学说(70年Wilson提出)u 与的相互作用与间的相互作用双氢睾酮学说示意图2022-7-5The First Hospital of Xinxiang Medical College5病理u通常将前列腺分为移行带移行带(尿道周围腺体、占5%)、外周带外周带、中央带中央带u增生的部分主要是尿道周围腺体u增生的腺体压迫外周带成为外科包膜u增生结节：基质型、腺泡型、混合型2022-7-5Th

3、e First Hospital of Xinxiang Medical College6病理u增生使前列腺段尿道弯曲、伸长、狭窄，导致膀胱出口（BOO）梗阻u梗阻代偿期代偿期：膀胱逼尿肌肥厚 梗阻失代偿期失代偿期：充溢性尿失禁、上尿路积水扩张、代谢产物潴留、尿毒症u增生的程度与梗阻程度不一定成正比2022-7-5The First Hospital of Xinxiang Medical College7临床表现最早出现的症状最重要的症状梗阻加重的表现血尿、感染、结石、肾积水、疝、痔等(实物标本)BPHBOOLUTS2022-7-5The First Hospital of Xinxiang

4、 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.尿不尽感0123452.间隔2h0123453.间断排尿0123454.憋尿困难0123455.尿线变细0123456.排尿费力0123457.夜尿次数012345I-PSS：Score(035)2022-7-5The First Hospital of Xinxiang Medical College9I-PSS Means 轻度增生轻度增生2022-7-5The First Hospital of Xinxiang Medical College10生活质量评分患者认为其现在的排尿状况非

5、常好好 满意半数满意多数不满不满意很痛苦评分0123456生活质量评分：L(06)2022-7-5The First Hospital of Xinxiang Medical College11诊断n增生：鸡蛋大小n 增生：鸭蛋大小n 增生：鹅蛋大小残余尿、尿流率、PSA测定或直接测定前列腺大小2022-7-5The First Hospital of Xinxiang Medical College12鉴别诊断u膀胱颈纤维化(膀胱颈挛缩)：慢性炎症所致，发病年龄较轻u前列腺癌：前列腺坚硬，表面不平，PSAu膀胱癌：指膀胱颈附近的膀胱癌，膀胱镜检可以鉴别u神经原性膀胱尿道功能障碍：有神经系统损

6、害的病史和体征u尿道狭窄：有尿道损伤、感染病史2022-7-5The First Hospital of Xinxiang Medical College13治疗u目的：缓解增生腺体所致的膀胱出口梗阻u膀胱出口梗阻(BOO)的原因：n增生腺体挤压尿道所致的机械性梗阻n增生腺体平滑肌张力所致的动力性梗阻u治疗方法：很多2022-7-5The First Hospital of Xinxiang Medical College14药物治疗 ：降低前列腺平滑肌张力 ：酚卞明 ：Hytrin(高特灵)：哈乐：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：舍尼通 等2022-

7、7-5The First Hospital of Xinxiang Medical College15手术治疗适应症：u残余尿量大于50ml u曾经出现过急性尿潴留u大量出血或反复肉眼血尿u病人迫切要求，身体状况能耐受手术手术方法：u耻骨上前列腺增生腺体摘除术 u耻骨后摘除术 u经会阴摘除术 u经尿道前列腺电切或电汽化术2022-7-5The First Hospital of Xinxiang Medical College16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)2022-7-5The First Hosp

8、ital of Xinxiang Medical College172022-7-5The First Hospital of Xinxiang Medical College182022-7-5The First Hospital of Xinxiang Medical College19经尿道增生腺体切除术2022-7-5The First Hospital of Xinxiang Medical College20前列腺电汽化术TUVPTransurethral Vaporization of the Prostate 2022-7-5The First Hospital of Xinx

9、iang Medical College21前列腺电切除术TURPTransurethral Resection of the Prostate 2022-7-5The First Hospital of Xinxiang Medical College22电切除的前列腺碎片2022-7-5The First Hospital of Xinxiang Medical College23前列腺钬激光切除术2022-7-5The First Hospital of Xinxiang Medical College24Laser Ablation of the Prostate 2022-7-5Th

10、e First Hospital of Xinxiang Medical College25前列腺两侧叶、中叶增生合并膀胱结石2022-7-5The First Hospital of Xinxiang Medical College26Treatment of BPHuPlacebouWatchful waitinguPharmacotherapynAlpha-blockersn5alpha reductase inhibitorsnPhytotherapyuSurgerynTURP TUVP TUIPnOpen prostatectomyuMinimally Invasive TherapyHyperthermia and thermotherapy(TUMT)Transurethral Needle Ablation of prostate(TUNA)Laser CoagulationuBalloon dilation祝大家学习进步2022年7月