前立腺肥大症に対する温熱療法 - 特に長期成績とその適応について -

Abstract

30例のバルーン非留置のBPH患者に計10回, 経直腸的温熱療法を行い, 自・他覚所見より短期および長期成績を検討した.1)短期成績としては, ほとんどの症例で治療後自覚症状の改善, とくに夜間排尿回数, 昼間排尿回数および尿線の改善がみられ, 1ヵ月間持続した.他覚所見としては, 残尿量, 最大尿流量率, 平均尿流量率の改善を多くの症例でみたが, 前立腺重量では治療前後で差はなかった.2) 6ヵ月の長期follow例では, 24例で自・他覚所見のいずれかで改善が持続し, 両方とも改善の持続した症例は16例であった.3)治療に伴う合併症としてはapplicator挿入時の痛みと温度上昇に伴う肛門内熱感程度で, 局所麻酔のみでapplicator挿入も容易で, 治療による肝, 腎障害などは全例でみられなかった.4)以上より, 合併症を有し手術困難なBPHに対し, 本治療法は有用な治療法の1つと考えられた

Transrectal hyperthermia was performed on 30 patients with benign prostatic hyperplasia twice a week for a total of ten times with the temperature of the prostatic tissue set at 43.0 degrees C. In our in vitro experiment using an agar phantom, the highest temperature was observed at approx. 1.5 cm from the point where the 915-MHz microwave was generated. Our histopathological study of the prostatic tissue, resected at open surgery after three days of hyperthermia, indicated that the effect of hyperthermia first occurred in the interstitial tissues, and then extended to the epithelial cells. Subjective symptoms and objective findings were evaluated. In almost all cases, improvement was observed in subjective symptoms after completion of the treatment. The residual urine volume improved significantly. Also, significant improvement was observed in our urodynamics study. In 16 out of 30 cases (53%), both subjective symptoms and objective findings were still improved after six months.