付 裕,成少平

良性前列腺增生（BPH）术后复发会直接影响手术的远期疗效。然而，文献中“复发”的涵义并不统一：有人指残留腺体再生长，有人指膀胱颈挛缩、尿道狭窄这类瘢痕性梗阻，也有人把逼尿肌不可逆损伤导致的持续下尿路症状（LUTS）算作复发。本文从患者、前列腺病灶、手术操作、术后随访四个维度梳理危险因素，并比较主流术式的远期再干预率。综合现有证据，年龄与复发其实只是弱相关，复发风险主要由代谢综合征、慢性前列腺炎等合并情况，以及前列腺体积和PSA水平决定。手术方式的影响最为直接：解剖性剜除术5年再治疗率仅4.4%，而前列腺尿道悬吊术、Rezūm这类微创术式可高达14%~16%。术后若PSA降幅不足、尿流率改善差、残余尿居高不下，预后多不理想。要厘清这些因素的独立作用，统一的结局定义和多因素校正缺一不可。

良性前列腺增生；术后复发；再手术；危险因素；术式比较

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