良性前列腺增生患者HoLEP及TURP围手术期血栓栓塞风险比较研究

发布时间：2018-02-05 01:16

本文关键词： 前列腺增生(BPH) HoLEP TURP 血栓栓塞　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过回顾性统计分析,初步了解TURP及HoLEP围手术期出现血栓栓塞的概率。进一步通过检测手术患者血液中反应全身促凝和抗凝,纤溶和抗纤溶指标,以及凝血功能常规检查,前瞻性纵向观察和横向比较经尿道前列腺电切术(Transurethral Resection Of The Prostate,TURP)和经尿道前列腺钬激光剜除术(Holmium Laser Enucleation Of The Prostate,HoLEP)对良性前列腺增生患者(Benignprostatic hyperplasia,BPH)围手术期血栓栓塞风险的影响。方法:(1)回顾性统计并分析自2013年1月至2017年3月在我院泌尿外科行TURP和HoLEP的患者病历资料,比较两组患者术后出现血栓相关性事件的比例。(2)选择特定医疗组2015年6月至2017年3月期间收治的70例良性前列腺增生患者,随机分为TURP组和HoLEP组,其中TURP组35例,HoLEP组35例。对于入组的患者进行详细的病史记录以及系统的体格检查和专科体检,完善前列腺B超,前列腺特异抗原(PSA)测定等术前检查,以及手术前的常规检查。研究指标测定:在手术开始前,术后第1天,术后第3天分别检测患者的凝血四项:活化部分凝血活酶时间(APTT),凝血酶原时间(PT),纤维蛋白原(FIB),凝血酶时间(TT),凝血酶原片段F 1+2和凝血酶-抗凝血酶复合物TAT,纤溶酶原激活物抑制剂PAI-1和组织纤溶酶原激活剂t-PA。术后观察与随访:术后14天行双下肢深静脉彩超检查,观察和记录患者术后并发症,并在术后1月对患者进行常规随访。结果:(1)2013年1月至2017年3月期间在我院行TURP术的患者有448例,其中3例发生了下肢静脉血栓伴肺梗塞,1例仅出现肺梗塞;行HoLEP术的患者有426例,其中1例发生了下肢静脉血栓,未出现肺梗塞患者。(2)70例患者中TURP组3例既往有脑梗或脑血管疾病史,HoLEP组2例有心梗病史,其余既往均无心脑血管和静脉血栓或肺栓塞史,无凝血障碍,未使用抗血小板或者抗凝药物,前列腺特异抗原(PSA)测定处于正常范围,最终纳入有效病例65例,其中行TURP的 32 例,行 HoLEP 的 33 例。HoLEP 组、TURP 组术前,F 1+2 和 TAT,PAI-1和t-PA及凝血四项比较,组间均无显著性差异(P0.05);术后第1天,PT、APTT、TT、FIB、F1+2、TAT、t-PA 组间无显著性差异(P0.05),TURP 组 PAI-1 高于HoLEP组,存在显著性差异(P0.05),TURP组及HoLEP组PT较术前升高,存在显著性差异(P0.05),APTT、TT、FIB、F1+2、TAT、t-PA 和 PAI-1 两组组内比较无显著性差异(P0.05);术后第3天,PT、APTT、TT、F1+2、TAT、t-PA组间比较差异无显著性意义(P0.05),TURP组FIB高于HoLEP组,存在显著性差异(P0.05),TURP组PAI-1高于HoLEP组,存在显著性差异(P0.05);TURP组APTT及TT与术前比较下降,存在显著性差异(P0.05),PT、FIB、F1+2、TAT、t-PA 和 PAI-1 组内比较无显著性差异(P0.05);HoLEP 组 PT、APTT、TT、FIB、F1+2、TAT、t-PA和PAI-1组内比较无显著性差异(P0.05)。术后2周及1月随访,65例患者均未发生血栓栓塞事件。结论:相对HoLEP,TURP术后的患者血液高凝,出现血栓栓塞事件的风险较高。
[Abstract]:Objective: to investigate the probability of thromboembolism in perioperative period of TURP and HoLEP by retrospective statistical analysis. The indexes of fibrinolysis and antifibrinolysis, as well as the routine examination of coagulation function. Prospective longitudinal and transverse comparison of transurethral Resection of The Prostate in transurethral resection of the prostate. TURP) and transurethral holmium laser enucleation of the prostate (TURP) and Holmium Enucleation of The Prostate. Hole P) was used to treat benign prostatic hyperplasia in patients with benign prostatic hyperplasia (BPH). Impact of perioperative thromboembolism risk. Methods: 1). The data of TURP and HoLEP in urology from January 2013 to March 2017 were analyzed retrospectively. To compare the proportion of thrombus related events between two groups.) 70 patients with benign prostatic hyperplasia were selected from June 2015 to March 2017 in a specific medical group. TURP group and HoLEP group were randomly divided into TURP group (35 cases) and Hole group (35 cases). Improve the pre-operation examination of prostate ultrasound, prostate specific antigen (PSA) determination, and routine examination before operation. Study indicators: before operation, 1 day after operation. On the third day after operation, four items of coagulation were detected: activated partial thromboplastin time (APTTT), prothrombin time (PTT), fibrinogen (FIBN) and thrombin time (TTT). Prothrombin fragment F12 and thrombin-antithrombin complex TAT. Plasminogen activator inhibitor (PAI-1) and tissue plasminogen activator (t-PA.). Postoperative observation and follow-up: 14 days after operation, deep vein ultrasonography was performed to observe and record postoperative complications. Routine follow-up was performed on January. Results from January 2013 to March 2017, 448 patients underwent TURP in our hospital. Among them, 3 cases had venous thrombosis of lower extremity with pulmonary infarction, only 1 case had pulmonary infarction. There were 426 patients undergoing HoLEP, of which 1 case had venous thrombosis of lower extremity, and 3 cases in TURP group had a history of cerebral infarction or cerebrovascular disease. In HoLEP group, 2 cases had a history of myocardial infarction, the rest had no history of cardiovascular and venous thrombosis or pulmonary embolism, no coagulation disorder, no use of antiplatelet or anticoagulant drugs. The detection of prostate specific antigen (PSA) was in the normal range, and 65 cases were included in the final effective cases, including 32 cases of TURP and 33 cases of HoLEP. There was no significant difference in F12, TATPAI-1, t-PA and coagulation between the TURP group and the control group (P 0.05). On the first day after operation, there was no significant difference between the two groups (P 0.05). The PAI-1 of TURP group was higher than that of HoLEP group, and there was significant difference (P 0.05). PT in HoLEP group and HoLEP group was higher than that before operation. There was no significant difference between the two groups (P0.05). There was no significant difference between the two groups (P0.05). On the 3rd day after operation, there was no significant difference in FIB between the two groups. The FIB of TURP group was higher than that of HoLEP group. There was significant difference in PAI-1 between P0.05TURP group and HoLEP group, and there was significant difference between P0.05TURP group and HoLEP group. The levels of APTT and TT in TURP group were significantly lower than those before operation (P 0.05). There was no significant difference between t-PA group and PAI-1 group (P 0.05). There was no significant difference between HoLEP group and PAI-1 group (P 0.05). All patients were followed up 2 weeks after operation and on January. Conclusion: the risk of thromboembolic events is higher than that of patients after Hole Pen TURP.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.8

【相似文献】