巨大良性前列腺增生1例报告并文献复习

目的:探讨巨大良性前列腺增生的临床特点、诊断和手术方法。方法:回顾分析1例巨大良性前列腺增生患者的临床资料,并复习国内外文献进行分析及讨论。结果:患者77岁,临床表现主要为夜尿增多、肉眼血尿。最大尿流率10ml/s,PSA37μg/L,CT显示前列腺大小为11cm×10cm×8cm。行耻骨后前列腺切除术,术后前列腺重量450g,病理结果示"良性前列腺增生"。术后21d康复出院,无明显并发症。国内文献报道,重量在200g以上有83例;国外文献报道,重量在500g以上有14例。国内报道的83例均通过手术治疗,大多数学者采用耻骨上经膀胱前列腺切除术,部分学者采用耻骨后前列腺切除术或经尿道前列腺切除术,术后效果良好。国外报道14例中11例采用耻骨上前列腺切除术,2例采用耻骨后前列腺切除术,1例采用两种方法。结论:巨大良性前列腺增生临床少见,定义尚未统一。根据临床表现和经直肠B超、前列腺CT等辅助检查可作出诊断。治疗应行前列腺切除术,手术方式有经尿道前列腺切除术、耻骨上经膀胱前列腺切除术或耻骨后前列腺切除术,以及腹腔镜前列腺切除术,具体术式应根据患者的实际情况及术者的手术经验而定。

Giant prostatic hyperplasia:A case report and review of the literature

Objective：To investigate the clinical features,diagnosis and surgical treatment of giant prostatic hyperplasia （GPH）.Methods： We retrospectively analyzed the clinical data of 1 case of GPH,and reviewed the relevant literature published at home and abroad.Results： The patient was 77 years of age.The main clinical features were increased nocturnal urine and gross hematuria.The maximum urinary flow rate was 10 ml/s,the total PSA was 37 μg/L and the prostate volume was 11 × 10 × 8 cm.Suprapubic prostatectomy was performed successfully,and the removed prostate weighed 450 g.Pathologic examination showed the case to be benign prostatic hyperplasia.The patient was discharged 21 days after surgery,without any obvious complications.We identified 83 cases with the prostate weighing over 200 g in the domestic literature,and 14 cases with the prostate volume exceeding 500 g in the foreign literature,mostly treated by suprapubic prostatectomy and only a few by retropubic prostatectomy.Conclusion： GPH,as a rare entity whose nomenclature is not yet agreed-on,can be diagnosed according to its clinical manifestations and the results of transrectal ultrasonography and prostate CT.Surgical methods most frequently adopted for its treatment include transurethral prostatectomy,transvesical suprapubic prostatectomy,retropubic prostatectomy,and laparoscopic prostatectomy.