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張瓈文 良性攝護腺肥大經攝護腺動脈栓塞和經尿道攝護腺刮除手術相比較:一隨機分配、開方式、單一中心追蹤2年結果 2022/5/5 下午 05:40:04 0
原 文 題  目 Prostatic Artery Embolisation Versus Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: 2-yr Outcomes of a Randomised, Open-label, Single-centre Trial
作  者 Dominik Abt et al
出  處 Eur Urol. 2021 Jul;80(1):34-42.
出版日期 July 2021
評 論

對於良性攝護腺肥大的治療,目前常以藥物及手術治療為主。對於藥物治療反應不佳的良性攝護腺肥大,可以考慮手術治療,目前手術方式以內視鏡經尿道攝護腺刮除手術為主,包含傳統的電刀刮除手術或是雷射手術。而近年來也有Transurethral Microwave Therapy、Prostatic Urethral Lift、Water Vapor Thermal Therapy等新興微創治療,但目前仍多在研究階段。
而近期攝護腺動脈栓塞(Prostate Artery Embolization)因不需住院、不需全身麻醉或半身麻醉、術中出血量少而被視為一替代手術之治療方式。本篇研究共103位病患,其中51位接受攝護腺動脈栓塞治療,而52位接受經尿道攝護腺刮除手術。在追蹤了24個月後,無論是最大尿流速、減少殘餘尿量、縮小攝護腺體積、改善膀胱壓力,及改善國際攝護腺症狀評分(IPSS)方面經尿道攝護腺刮除手術皆優於攝護腺動脈栓塞治療,達統計顯著差異。在治療導致的不良反應方面,攝護腺動脈栓塞較經尿道攝護腺刮除手術來得少,但嚴重度兩者無差異。而在經攝護腺動脈栓塞手術後,有21%的病患因對治療滿意度不佳而在2年內再接受經尿道攝護腺刮除手術。

abstract

Prostate artery embolization has been a new alterative management for benign prostatic obstruction with advantage in local anesthesia and continuation of anticoagulant. However, there is still controversy of prostate artery embolization regarding outcome comparing traditional TURP. This study was the randomize control trial investigate the outcome of the two procedure with two years follow up. After the two year follow up, the mean reduction in IPSS, improvement of maximum urinary flow rate, reduction of post void residual urine, and reduction of prostate volume were superior in TURP group. 21% of patients underwent PAE required TURP within 2years due to unsatisfying clinical outcome. Improvements of subjective and objective outcomes are superior after TURP, and PAE does not represent a definitive treatment for a relevant proportion of patients.
Patients requiring a maximum relief of bladder outlet obstruction such as acute urinary retention may not the appropriate candidate for PAE. PAE may be an alteration if patient is unsuitable for operation and accepting outcomes inferior to those of more invasive surgical treatments.

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