经尿道前列腺等离子电切术后并发尿道狭窄的危险因素分析及防治

发布时间：2018-04-18 16:09

  本文选题：良性前列腺增生 + 经尿道前列腺等离子电切术　； 参考：《福建医科大学》2014年硕士论文

【摘要】：目的：探讨经尿道前列腺等离子电切术（PKRP）后发生尿道狭窄的危险因素及其防治措施。 方法：福建医科大学附属第一医院泌尿外科2011年1月-2013年12月因BPH行PKRP术的患者684例，其中2011年225例，2012年217例，，2013年242例。术后发生尿道狭窄的患者15例（尿道狭窄组），其年龄为59-87（71.4±7.1）岁。分别从各年份中随机抽取未发生尿道狭窄的病例15例，共45例（无尿道狭窄组），其年龄为57-88（72.9±7.2）岁。 通过对患者再次入院就诊、查阅电子病历和电话方式进行随访，收集此60例患者的数据资料。为分析TURP术后患者发生尿道狭窄的危险因素，选用包括患者年龄、BPH病程时间、术前尿路感染、术前前列腺大小、手术切除前列腺重量、手术时间、术后留置导尿管时间7个指标。所有数据使用SPSS17.0软件进行分析。计量资料使用独立样本t检验，数据用均数±标准差（x±s）表示；计数资料使用χ2检验；P＜0.05有统计学意义；筛选出P＜0.05的自变量，纳入Logistic回归模型进行多因素分析。 结果：患者年龄、BPH病程时间、术前前列腺大小、手术切除前列腺重量、手术时间五项因素其P＞0.05，与PKRP术后尿道狭窄的发生无相关性。术前尿路感染、术后留置导尿管时间两项因素的P＜0.05，与PKRP术后尿道狭窄的发生有相关性。进一步的Logistic多因素分析结果显示，术前尿路感染、术后留置导尿管时间是PKRP术后发生尿道狭窄的独立危险因素（P＜0.05），OR值分别为8.050、1.607。 结论：术前合并尿路感染、术后留置导尿管时间过长是PKRP术后发生尿道狭窄的独立危险因素。积极控制术前及术后尿路感染、避免术中操作损伤、术后留置导尿管不宜过粗、留置时间不宜过长等是预防PKRP术后发生尿道狭窄的有效措施。加强对PKRP术后患者的随访，做到早发现、早治疗，并根据狭窄的部位、长度、程度等因素选择合适的治疗方法，是PKRP术后尿道狭窄治愈的关键。
[Abstract]:Objective: to investigate the risk factors and prevention of urethral stricture after transurethral plasma resection of prostate (TURP).Methods: from January 2011 to December 2013, 684 patients underwent PKRP in Urology Department of the first affiliated Hospital of Fujian Medical University, including 225 cases in 2011, 217 cases in 2012 and 242 cases in 2013.There were 15 patients with urethral stricture after operation (the age of urethral stricture group was 71.4 卤7.1 years old).15 cases of urethral stricture were randomly selected from each year. There were 45 cases (no urethral stricture group) whose age was 57-88 (72.9 卤7.2) years.The data of 60 patients were collected through readmission, electronic medical records and telephone follow-up.In order to analyze the risk factors of urethral stricture after TURP, the age and duration of urethral stricture, urinary tract infection before operation, prostate size before operation, the weight of prostatic gland after operation, and operative time were selected to analyze the risk factors of urethral stricture.Postoperative indwelling urethral catheter time 7 indicators.All data are analyzed using SPSS17.0 software.The measured data were expressed by the mean 卤standard deviation (x 卤s) and the count data by 蠂 2 test (P < 0. 05). The independent variables of P < 0. 05 were screened out and analyzed by Logistic regression model.Results: the age and duration of PKRP, the size of prostate before operation, the weight of resection prostate and the operative time had no correlation with the occurrence of urethral stricture after PKRP.Urinary tract infection before operation and time of indwelling urethral catheter after operation (P < 0.05) were correlated with the occurrence of urethral stricture after PKRP.Further Logistic multivariate analysis showed that preoperative urinary tract infection and postoperative indwelling time were independent risk factors for urethral stricture after PKRP (P < 0.05) and OR values were 8.050 卤1.607, respectively.Conclusion: preoperative urinary tract infection and postoperative catheter length are independent risk factors for urethral stricture after PKRP.The effective measures to prevent urethral stricture after PKRP are to control urinary tract infection before and after operation, to avoid operative injury, to prevent urethral stricture after PKRP.The key to cure urethral stricture after PKRP is to strengthen the follow-up of patients after PKRP, to find and treat it early, and to select appropriate treatment methods according to the location, length and degree of stenosis.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.6


本文编号：1769091