良性前列腺增生课件

,单击此处编辑母板标题样式,单击此处编辑幻灯片母版样式,第二级,第三级,第四级,第五级,*,The First Hospital of Xinxiang Medical College,*,良性前列腺增生,Benign Prostatic Hyperplasia,BPH,1,2024/10/5,The First Hospital of Xinxiang Medical College,2,前列腺的位置,2024/10/5,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,北方地区的发病率高于南方,通常前列腺从,35,40,岁开始增生，,50,岁出现症状，,60,岁需要进行有效的治疗,2024/10/5,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,2024/10/5,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为外科包膜,增生结节：基质型、腺泡型、混合型,2024/10/5,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,2024/10/5,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,),BPH,BOO,LUTS,2024/10/5,The First Hospital of Xinxiang Medical College,8,国际前列腺症状评分,(I-PSS),过去,1,个月症状,无,1/5,1/2,总是,1.,尿不尽感,0,1,2,3,4,5,2.,间隔,2h,0,1,2,3,4,5,3.,间断排尿,0,1,2,3,4,5,4.,憋尿困难,0,1,2,3,4,5,5.,尿线变细,0,1,2,3,4,5,6.,排尿费力,0,1,2,3,4,5,7.,夜尿次数,0,1,2,3,4,5,I-PSS,：,Score(0,35),2024/10/5,The First Hospital of Xinxiang Medical College,9,I-PSS Means,0-7,分,轻度增生,8-19,分,中度增生,20-35,分,重度增生,2024/10/5,The First Hospital of Xinxiang Medical College,10,生活质量评分,患者认为其现在的排尿状况,非常好,好,满意,半数满意,多数不满,不满意,很痛苦,评分,0,1,2,3,4,5,6,生活质量评分：,L(0,6),2024/10/5,The First Hospital of Xinxiang Medical 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,2024/10/5,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,：有尿道损伤、感染病史,2024/10/5,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,2024/10/5,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,),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,2024/10/5,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,2024/10/5,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“金标准”,(Gold Standard),2024/10/5,The First Hospital of Xinxiang Medical College,17,2024/10/5,The First Hospital of Xinxiang Medical College,18,2024/10/5,The First Hospital of Xinxiang Medical College,19,经尿道增生腺体切除术,2024/10/5,The First Hospital of Xinxiang Medical College,20,前列腺电汽化术,TUVP,Transurethral Vaporization of the Prostate,2024/10/5,The First Hospital of Xinxiang Medical College,21,前列腺电切除术,TURP,Transurethral Resection of the Prostate,2024/10/5,The First Hospital of Xinxiang Medical College,22,电切除的前列腺碎片,2024/10/5,The First Hospital of Xinxiang Medical College,23,前列腺钬激光切除术,2024/10/5,The First Hospital of Xinxiang Medical College,24,Laser Ablation of the Prostate,2024/10/5,The First Hospital of Xinxiang Medical College,25,前列腺两侧叶、中叶增生合并膀胱结石,2024/10/5,The First Hospital of Xinxiang Medical College,26,Treatment of BPH,Placebo,Watchful waiting,Pharmacotherapy,Alpha-blockers,5alpha reductase inhibitors,Phytotherapy,Surgery,TURP TUVP TUIP,Open prostatectomy,Minimally Invasive Therapy,Hyperthermia and thermotherapy(TUMT),Transurethral Needle Ablation of prostate(TUNA),Laser Coagulation,Balloon dilation,祝大家学习进步,十月 24,27,