王永春

急性细菌性前列腺炎的诊断与治疗<p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">1.体检及直肠指诊</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">体检时可发现耻骨上压痛、不适感，有尿潴留者可触及耻骨上膨隆的膀胱。直肠指检可发现前列腺肿胀饱满、触痛，整个或部分腺体坚韧不规则，部分可有结节。如出现前列腺脓肿可触及波动感。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">2.前列腺液检查</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">大量白细胞或脓细胞以及巨噬细菌，培养有大量细菌生长。白细胞的多少与症状的严重程度不相关。但是急性期禁止行前列腺按摩。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">3.尿常规分析及尿沉渣检查</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">可见白细胞及红细胞，部分患者可有脓细胞。尿培养常能发现致病菌。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">4.超声波检查</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">可正常或轻度增大，形态尚对称。包膜增厚但无中断，内部回声多呈分布不均匀的低回声。当出现脓肿时，脓肿区呈边缘不齐的厚壁的无回声区或低回声区，无回声区内可有分隔。1.急性尿潴留</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">急性前列腺炎引起局部充血、肿胀、压迫尿道以致排尿困难或导致急性尿潴留。脓肿多见于20～40岁患者，以直肠症状及尿潴留较为多见。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">2.急性精囊或附睾炎及输精管炎</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">急性前列腺炎易扩散至精囊，引起急性精囊炎。同时细菌可逆运行经淋巴管进入输精管的壁层及外鞘导致附睾炎，局部肿痛明显。部分患者可有血精。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">3.急性膀胱炎</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">有膀胱刺激症状、尿道溢液、排尿困难、下腹会阴及下腰疼痛等表现。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">4.精索淋巴结肿大或有触痛</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">前列腺与精索淋巴在骨盆中有交通支，前列腺急性炎症时波及精索，引起精索淋巴结肿大且伴有触痛。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">5.性功能障碍</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">急性炎症期，前列腺充血、水肿或有脓肿形成，可有射精痛、疼痛性勃起、性欲减退、性交痛、勃起功能障碍、血精等治疗</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">1.一般治疗</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">应卧床休息5～7天，大量饮水，禁忌饮酒和食用刺激性食物。可行热水坐浴或会阴部热敷，并保持大便通畅，禁忌性生活。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">2.抗生素治疗</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">一旦得到临床诊断立即使用抗生素治疗。当患者全身症状明显，体温较高，血中白细胞明显升高时，应通过静脉给药；推荐开始时使用如：广谱青霉素、三代头孢菌素、氨基糖苷类或氟喹诺酮类。当患者全身症状不重，体温及血象正常时，可口服给药，疗程至少为1个月。应选用能够弥散进入前列腺内且快速有效的抗感染药物，迅速控制症状，以防转为慢性前列腺炎。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">3.对症治疗</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">如发生高热，应对症给予退热药。如膀胱刺激征明显，要针对病证用药。如发生排尿困难或尿潴留，应行暂时性耻骨上膀胱穿刺造口以引流尿液，不宜行留置导尿术。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">4.手术治疗</p> <p style="box-sizing: border-box; margin: 15px 0px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">如果急性前列腺炎已形成前列腺脓肿，则应经直肠或经会阴部行切开引流术。如果脓肿局限于前列腺内，可用尿道镜行前列腺穿刺排脓术。</p>

前列腺增生的常见症状<p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">良性前列腺增生的早期由于代偿，症状不典型，随着下尿路梗阻加重，症状逐渐明显，临床症状包括储尿期症状，排尿期症状以及排尿后症状。由于病程进展缓慢，难以确定起病时间。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">1.储尿期症状</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">该期的主要症状包括尿频、尿急、尿失禁以及夜尿增多等。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（1）尿频、夜尿增多尿频为早期症状，夜尿次数增加，但每次尿量不多。膀胱逼尿肌失代偿后，发生慢性尿潴留，膀胱的有效容量因而减少，排尿间隔时间更为缩短。若伴有膀胱结石或感染，则尿频愈加明显，且伴有尿痛。尿频是前列腺增生最早出现的症状。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（2）尿急、尿失禁下尿路梗阻时，50%～80%的患者有尿急或急迫性尿失禁。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">2.排尿期症状</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">该期症状包括排尿踌躇、排尿困难以及间断排尿等。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">随着腺体增大，机械性梗阻加重，排尿困难加重，下尿路梗阻的程度与腺体大小不成正比。由于尿道阻力增加，患者排尿起始延缓，排尿时间延长，射程不远，尿线细而无力。小便分叉，有排尿不尽感觉。如梗阻进一步加重，患者必须增加腹压以帮助排尿。呼吸使腹压增减，出现尿流中断及淋漓。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">3.排尿后症状</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">该期症状包括排尿不尽，尿后滴沥等。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">尿不尽、残余尿增多：残余尿是膀胱逼尿肌失代偿的结果。当残余尿量很大，膀胱过度膨胀且压力很高，高于尿道阻力，尿便自行从尿道溢出，称充溢性尿失禁。有的患者平时残余尿不多，但在受凉、饮酒、憋尿，服用药物或有其他原因引起交感神经兴奋时，可突然发生急性尿潴留。患者尿潴留的症状可时好时坏。部分患者可以是急性尿潴留为首发症状。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">4.其他症状</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（1）血尿前列腺黏膜上毛细血管充血及小血管扩张并受到增大腺体的牵拉或与膀胱摩擦，当膀胱收缩时可以引起镜下或肉眼血尿，是老年男性常见的血尿原因之一。膀胱镜检查、金属导尿管导尿、急性尿潴留导尿时膀胱突然减压，均易引起严重血尿。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（2）泌尿系感染尿潴留常导致泌尿系感染，可出现尿急、尿频、排尿困难等症状，且伴有尿痛。当继发上尿路感染时，会出现发热、腰痛及全身中毒症状。平时患者虽无尿路感染症状，但尿中可有较多白细胞，或尿培养有细菌生长，手术前应治疗。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（3）膀胱结石下尿路梗阻，特别在有残余尿时，尿液在膀胱内停留时间延长，可逐渐形成结石。伴发膀胱结石时，可出现尿线中断，排尿末疼痛，改变体位后方可排尿等表现。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（4）肾功能损害多由于输尿管反流，肾积水导致肾功能破坏，患者就诊时的主诉常为食欲不振、贫血、血压升高，或嗜睡和意识迟钝。因此，对男性老年人出现不明原因的肾功能不全症状，应首先排除良性前列腺增生。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（5）长期下尿路梗阻可出现因膀胱憩室充盈所致的下腹部包块或肾积水引起的上腹部包块。长期依靠增加腹压帮助排尿可引起疝，脱肛，痔疮等等</p>

前列腺增生的病因<p><span style="caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; font-size: 17px; text-align: justify; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%; background-color: #ffffff;">有关良性前列腺增生的发病机制研究颇多，但病因至今仍未能阐明。可能由于上皮和间质细胞增殖和细胞凋亡的平衡遭到破坏，其他相关因素：雄激素及其与雌激素的相互作用、前列腺间质与腺上皮细胞的相互作用、生长因子、炎症细胞、神经递质及遗传因素等。目前已知良性前列腺增生必须具备有功能的睾丸及年龄增长两个条件。近年来也注意到吸烟、肥胖及酗酒、家族史、人种及地理环境对BPH发生的关系。</span></p>

前列腺增生的治疗<p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">良性前列腺增生的危害性在于引起下尿路梗阻后所产生的病理生理改变。其病理个体差异性很大，而且也不都呈进行性发展。一部分病变至一定程度即不再发展，所以即便出现轻度梗阻症状也并非均需手术。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">1.观察等待</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">对症状轻微，IPSS评分7分以下可观察，无需治疗。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">2.药物治疗</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（1）5&alpha;-还原酶抑制剂适用于治疗前列腺体积增大同时伴中、重度下尿路症状的BPH患者。研究发现5&alpha;-还原酶是睾酮向双氢睾酮转变的重要酶。双氢睾酮在良性前列腺增生中有一定的作用，因此采用5&alpha;-还原酶抑制剂可以对增生予以一定的抑制。建议使用3个月以上，停药后症状容易反复。常用药物有非那雄胺，度他雄胺等等。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（2）&alpha;1-受体阻滞剂适用于有中、重度下尿路症状的BPH患者。目前认为此类药物可以改善尿路动力性梗阻，使阻力下降以改善症状，常用药有高特灵，盐酸坦索罗辛缓释胶囊等。此类药的常见副作用包括头晕、头痛、乏力、困倦、体位性低血压、异常射精等。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（3）其他包括M受体拮抗剂，植物制剂，中药等。M受体拮抗剂通过阻断膀胱M受体，缓解逼尿肌过度收缩，降低膀胱敏感性，从而改善BPH患者的贮尿期症状。植物制剂如前列疏通胶囊，普乐安片等适用于BPH及相关下尿路症状的治疗。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">综上所述，进行药物治疗前对病情应有全面估计，对药物的副作用及长期用药的可能性等也应充分考虑。观察药物疗效应长期随访，定期行尿流动力学检查，以免延误手术时机。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">3.手术治疗</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">手术仍为良性前列腺增生的重要治疗方法，适用于具有中、重度LUTS并已明显影响生活质量的BPH患者。经典的外科手术方法有经尿道前列腺电切术(Transurethralresectionoftheprostate,TURP)、经尿道前列腺切开术(Transurethralincisionoftheprostate,TUIP)以及开放性前列腺摘除术。目前TURP仍是BPH治疗的&ldquo;金标准&rdquo;。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">手术适应证为：①有下尿路梗阻症状，尿流动力学检查已明显改变，或残余尿在50m以上；②不稳定膀胱症状严重；③已引起上尿路梗阻及肾功能损害；④一次以上发作急性尿潴留，或反复发作的尿路感染、肉眼血尿；⑤并发膀胱结石者临床判断不解除下尿路梗阻难以达到治疗效果者。对有长期尿路梗阻，肾功能已有明显损害，严重尿路感染或已发生急性尿潴留的患者，应先留置导尿管解除梗阻，待感染得到控制，肾功能恢复后再行手术。如插入导尿管困难或插管时间长已引起尿道炎时，可改行耻骨上膀胱穿刺造瘘。应严格掌握急诊前列腺切除手术的适应证。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">4.微创治疗</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（1）经尿道前列腺电汽化术(TUVP)适用于凝血功能较差的和前列腺体积较小的BPH患者，是TUIP或TURP的另外一种选择。主要是电极金属材料学创新，使其生物学热效应不同于前者。由于热转化快，可产生400℃高温，迅速造成组织汽化，或产生凝固性坏死，其止血特点极其显著，因此临床应用显示：①适应证增加：60g以上的腺体可施行。②术野清晰：由于止血效果显著，冲洗液清晰，便于手术。③手术时间减少：由于减少了止血步骤，故手术切除加快，缩短了手术时间。④并发症减少：不易产生水中毒（凝固层厚），清晰术野减少了误伤，不易产生括约肌及包膜损伤。⑤术后恢复快：冲洗时间缩短。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（2）经尿道前列腺等离子双极电切术(TUPKP)和经尿道等离子前列腺剜除术(TUKEP)是使用等离子双极电切系统，并以与单极TURP相似的手术方式经行经尿道前列腺切除手术。TUPKP的主要优点包括术中、术后出血少，降低输血率和缩短术后导尿和住院时间；TUKEP将前列腺于包膜内切除，更加符合前列腺解剖结构，具有切除前列腺增生组织更完整、术后复发率低、术中出血少等特点。。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（3）微波治疗适用于药物治疗无效(或不愿意长期服药)而又不愿意接受手术的患者，以及伴反复尿潴留而又不能接受外科手术的高危患者。系利用微波对生物组织的热凝固原理以达到治疗目的。微波放射极的放置可通过直肠超声波定位，或经尿道镜直视下定位。后者可准确地避开尿道外括约肌，减少尿失禁的并发症。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（4）激光治疗激光手术的共同特点是术中出血相对较少，尤其适于高危因素的患者，如高龄、贫血、重要脏器功能减退等。利用激光热效应凝固汽化或切除前列腺组织，方法类似经尿道腔内操作。有表面照射，有插入热疗，也有利用激光束切除腺体。疗效肯定的是用激光剜除腺体，从膀胱将组织粉碎吸出，远期疗效和价格性能比有待观察。</p>

前列腺增生的诊断<p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">良性前列腺增生患者由于为老年患者常合并有其他慢性疾病。诊断时应重视患者全身情况，进行详细问诊、体检、化验，注意心、肺、肝、肾功能。排尿困难症状结合诸项检查，可明确诊断。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">1.IPSS评分</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">1995年国际泌尿外科学会（SIU）推出了IPSS评分体系，力图将症状学量化便于比较和协助诊断，也可作为治疗后评价标准。该体系通过6个问题回答确定分数，最高达35分，目前认为7分以下为轻度，7～18分中度，18分以上为重度，需外科处理。IPSS是目前国际公认的判断BPH患者症状严重程度的最佳手段，但主要是BPH患者下尿路症状严重程度的主观反映，与最大尿流率、残余尿量以及前列腺体积无明显相关性，临床工作中可采取此评分体系协助诊疗。2.问病史</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（1）下尿路症状的特点、持续时间及其伴随症状；</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（2）手术史、外伤史，尤其是盆腔手术或外伤史；</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（3)了解既往史，包括性传播疾病、糖尿病、神经系统疾病、可能与夜尿症有关的心脏病病史；</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（4）用药史，了解患者目前或近期是否服用影响膀胱出口功能或导致LUTS的药物；</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（5）患者的一般状况。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">鉴别诊断</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">1.膀胱颈挛缩</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">患者有下尿路梗阻症状，直肠指诊未发现前列腺明显增大，除可能系增大腺叶突向膀胱外，还应考虑膀胱颈挛缩的可能。一般认为膀胱颈挛缩继发于炎症病变。膀胱颈部平滑肌为结缔组织所代替，可伴有炎症。膀胱颈挛缩患者有较长的下尿路梗阻病史。膀胱镜检查时，膀胱颈抬高，后尿道与膀胱三角区收缩变短。膀胱镜下见前列腺段尿道无挤压变形，尿道内口缩小。而单纯的良性前列腺增生腺叶突向膀胱颈部时，被柔软黏膜覆盖，膀胱三角区下陷，后尿道延长。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">膀胱颈挛缩可同时伴有良性前列腺增生，由于增生腺体与外科包膜之间分界不清，摘除术常较困难，且腺体较直肠指诊或B超预测者明显为小。如摘除腺体后不同时处理挛缩的膀胱颈，下尿路梗阻难以解除。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">治疗可试用&alpha;-受体阻滞剂。如症状严重，反复发作尿路感染，或尿流动力学检查异常时，可考虑行经尿道电切，耻骨上经膀胱颈楔形切除或膀胱颈Y-V成形术。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">2.前列腺癌</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">前列腺癌尤其是导管癌类型可能以下尿路梗阻为首发症状。部分患者则是在良性前列腺增生的同时伴发前列腺癌，血清PSA（前列腺特异性抗原）升高，多&gt;10.0ng/ml。直肠指检前列腺表面不光滑，岩石样感觉。经直肠活检，B超引导更佳，经病理检查可明确诊断。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">3.神经性膀胱、逼尿肌括约肌协同失调</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">常表现为下尿路排尿异常，尿失禁等表现。需详细询问有无外伤史，检查有无提肛反射，应依靠尿流动力学检查加以排除，如充盈性膀胱测压，尿道压力图，压力/流率同步检测。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">4.无力性膀胱（膀胱壁老化）</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">表现为尿潴留、下尿路排尿异常，大量残留尿，应与良性前列腺增生相鉴别，应排除损伤、炎症、糖尿病等因素，主要也通过尿流动力学检查。特别尿道压力图，压力/流率同步检测加以鉴别。膀胱压图显示膀胱压力低，无收缩压力波形等。</p>

精索静脉曲张的病因<p><span style="caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; font-size: 17px; text-align: justify; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%; background-color: #ffffff;">精索静脉曲张（varicocele，VC）是一种血管病变，指精索内蔓状静脉丛的异常扩张、伸长和迂曲，可导致疼痛不适及进行性睾丸功能减退，是男性不育的常见原因之一。因其相关的阴囊疼痛不适、不育与睾丸萎缩等而广受关注。是常见的男性泌尿生殖系统疾病。多见于青壮年，发病率占正常男性人群的10%～15%，在男性不育症中占19%～41%。精索静脉曲张是由于包绕精索的精索静脉和蔓状静脉丛的扩张而引起的血管性精子发生障碍。通常见于左侧，约占77%～92%，亦可双侧发病，约占7%～22%，少见单发于右侧，约占1%。传统手术采用腹股沟切口，作高位结扎精索内静脉，并切除阴囊内部分扩张静脉。</span><span style="caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; font-size: 17px; text-align: justify; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">普通男性人群中精索静脉曲张的患病率为10%～15%，在原发性男性不育中占到30%～40%，在继发性不育中为69%～81%。精索静脉曲张患者的一级亲属共患病概率显著增加：有21.1%父亲和36.2%兄弟可能均出现精索静脉曲张。</span></p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">精索静脉曲张按年龄可分为成年型和青少年性。按病因可分为原发性和继发性。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">按病因可分为原发性及继发性VC两种。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">1.原发性VC</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">左侧精索静脉曲张较右侧常见，原因可能是：①静脉血管内压力增高，因左侧精索静脉行程长并呈直角汇入左肾静脉；②&ldquo;胡桃夹&rdquo;现象（NCS），肠系膜上动脉和主动脉压迫左肾静脉，影响左精索内静脉回流甚至导致反流，即&ldquo;胡桃夹&rdquo;现象（NCS）；③精索内静脉周围的结缔组织薄弱及静脉瓣膜缺如常见于左侧。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">原发性精索静脉曲张发生的有关因素：①精索静脉瓣缺如或功能不良导致血液反流；精索静脉管壁及周围结缔组织薄弱，或提睾肌发育不全等解剖学因素引起。③直立姿势影响精索静脉回流。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">2.继发性VC</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">病因及疾病有：左肾静脉或腔静脉瘤栓阻塞、肾肿瘤、腹腔内或腹膜后肿瘤，左肾静脉或腔静脉瘤栓阻塞、肾肿瘤、盆腔肿瘤、巨大肾积水，异位血管压迫上行的精索静脉等</p>

精索静脉曲张治疗方法<p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">应根据患者是否伴有不育或精液质量异常、有无临床症状、静脉曲张程度及有无其他并发症等情况给予治疗。治疗方法包括一般治疗、药物治疗和手术治疗。手术治疗是主要的治疗方法，部分患者可以达到理想的治疗效果。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">1.一般治疗</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">包括生活方式、饮食调节、物理疗法等，如：戒烟限酒、饮食清淡、回避增加腹压的运动；降温疗法或阴囊托等。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">2.药物治疗</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（1）针对精索静脉曲张的药物</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">1）七叶皂苷类：抗炎、抗渗出、保护静脉壁的胶原纤维作用，可以逐步恢复静脉管壁的弹性和收缩功能，增加静脉血液回流速度，降低静脉压。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">2）黄酮类：抗炎、抗氧化作用，可以提高静脉张力，降低毛细血管通透性，提高淋巴回流率，减轻水肿；改善临床型精索静脉曲张引起的疼痛症状。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（2）改善症状的药物：针对局部疼痛不适可以使用非甾体类抗炎药，如布洛芬等。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">（3）改善精液质量的药物：对于合并生精功能障碍且有生育要求的精索静脉曲张患者，可使用促进精子发生、改善精液治疗的药物。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">3.手术治疗</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">首先应排除肾肿瘤、肾积水、腹膜后肿瘤、异位血管等继发性因素。精索静脉曲张的外科治疗方式包括手术治疗和介入治疗（顺行或逆行）。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">手术治疗包括传统经腹股沟途径、经腹膜后途经、经腹股沟下途径精索静脉结扎术、显微技术腹股沟途径或者腹股沟下途径精索静脉结扎术，腹腔镜精索静脉结扎术等等原发性VC伴有不育或精液异常者不论症状轻重均为治疗指征，目前手术治疗有经腹股沟管精索内静脉高位结扎术、腹腔镜手术、经腹膜后精索内静脉高位结扎，精索静脉介入栓塞术等。经腹膜后高位结扎精索静脉相较于经腹股沟管手术和腹腔镜手术具有手术创伤小，不易损伤其他血管，不易漏扎精索静脉，手术时间短，手术费用低及术后并发症，复发率低等优点，是单侧精索静脉曲张的首选治疗方法。也可以选择显微镜下血管分流术。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">手术联合药物治疗者的精液参数改善程度明显优于单纯手术的治疗。</p>

经皮肾镜碎石后注意事项<p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">1.肾结石手术刚结束后需密切监测生命体征变化，复查血常规，警惕感染性的可能；观察尿管和肾造瘘管内引流液的颜色，一旦出血加重甚至发生血凝块堵塞引流管，需加强止血、对症治疗。或出现血红蛋白持续下降，应及时采取对症处置。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">2.对于全麻或椎管内麻醉患者，术后排气后多饮水，每天的尿量尽量保持在1500ml-2000ml，可以预防尿路感染、促进碎结石下移排出。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">3.术后短期内需注意休息，避免体内双J管或肾造瘘管的移位甚至滑脱，导致二次出血、腰疼及尿路刺激征；输尿管内的双J管拔除后，需多活动以促进碎石块下移排出。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">4.遵照医嘱，及时拔除体内的双J管，以避免双J管结石附着致拔管失败，造成二次住院做微创或开放手术拔除双J管的可能。一般术后一个月拔出。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">5.双J管拔除后需密切注意患者症状和体征变化，如频繁发作患侧肾绞痛，需警惕碎石块下移堵塞输尿管的可能；如突发寒战、高热、腰部胀痛，需考虑输尿管梗阻继发肾积水感染的可能。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">6.双J管拔除后可口服3天抗菌素预防尿路感染，口服排石药物及&alpha;受体阻滞剂两周促进术后残留碎石块的下移排出。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">7.收集排出的碎石做&ldquo;结石成分分析&rdquo;检查，明确体内结石的成分，采取相应的预防措施。</p> <p style="box-sizing: border-box; margin: 15px 0px; padding: 0px; border: 0px; font-size: 17px; vertical-align: baseline; line-height: 28px; text-align: justify; word-break: break-all; caret-color: #222222; color: #222222; font-family: PingFangSC, 'Helvetica Neue', Helvetica, 'Nimbus Sans L', Arial, 'Liberation Sans', 'Hiragino Sans GB', 'Source Han Sans CN Normal', 'Microsoft YaHei', 'Wenquanyi Micro Hei', 'WenQuanYi Zen Hei', 'ST Heiti', SimHei, 'WenQuanYi Zen Hei Sharp', sans-serif; -webkit-tap-highlight-color: rgba(0, 0, 0, 0); -webkit-text-size-adjust: 100%;">8.每3个月定期复查泌尿系统B超，了解结石复发情况及肾脏积水恢复情况。</p>