低压虹吸系统在经尿道前列腺电切术中的应用

发布时间：2018-08-19 12:03

【摘要】：目的探索利用自制膀胱测压预警系统实施低压经尿道前列腺电切术(TURP)的可行性与安全性。方法 2014年1月-2016年1月167例行前列腺电切的前列腺增生(BPH)患者按随机数字表法分为测压组(A组)和非测压组(B组)。A组85例,采用经皮膀胱造瘘+TURP术式42例(A1组),连续冲洗鞘式TURP术式43例(A2组)。B组82例,采用经皮膀胱造瘘+TURP术式42例(B1组),连续冲洗鞘式TURP术式40例(B2组)。A组利用自制虹吸管经膀胱穿刺形成膀胱测压预警系统进行膀胱测压,实时监测膀胱压力,保持膀胱低压状态进行TURP手术。4组均检测术前、术后血Na~+,记录术中手术时间、术中出血量、切除前列腺质量、尿色转清时间,评估手术前后的国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、残余尿量(PVR)和生活质量评分(QOL)。结果 A组血Na~+术前术后差异无统计学意义,B组血Na~+术前术后差异有统计学意义,提示测压组较非测压组更安全。测压组A1与非测压组B1、测压组A2与非测压组B2相比可用于切除前列腺组织的安全手术时间更长、前列腺切除质量更多,术后尿色转清时间更短,Qmax、IPSS改善更佳,提示测压组较非测压组治疗效果更佳。结论自制膀胱测压预警系统可以及时发现TURP术中膀胱内高压状态,可以及时处理造成高压的原因,始终能保持低压冲洗下进行TURP,延长了安全手术时间,增加组织切除率,明显降低电切综合征的发生,使TURP更具安全性。
[Abstract]:Objective to explore the feasibility and safety of low pressure transurethral resection of prostate (TURP) by using self-made bladder pressure-warning system. Methods from January 2014 to January 2016, 167 patients with benign prostatic hyperplasia (BPH) were randomly divided into two groups: group A (n = 85) and group B (n = 85). 42 cases (group A1) were treated with percutaneous cystostomy (TURP), and 82 cases (group A 2) with continuous rinsing sheath type TURP (group A 2) and group B (n = 82). 42 cases (group B1) of percutaneous cystostomy (group B1) and 40 cases (group B2) of continuous washing sheath type TURP (group A) were used to measure bladder pressure by using self-made siphon to form bladder pressure-warning system through bladder puncture, and to monitor bladder pressure in real time. Before and after operation, the blood Na ~, the time of operation, the amount of blood loss, the quality of prostatectomy and the time of urine color change were recorded in the group of TURP operation with maintenance of low pressure of bladder. Assessment of preoperative and postoperative international prostatic symptom scores (IPSS), maximum uroflow rate (Qmax), residual urine volume (PVR) and quality of life score (QOL). Results there was no significant difference in blood Na ~ before and after operation between group A and group B. there was significant difference between group B and group A, suggesting that the blood Na ~ in group A was more safe than that in group B. Group A1 and group B _ 1, group A _ 2 and group B _ 2 can be used to remove prostate tissue for longer safe operation time, prostate resection quality more, postoperative urine color conversion time is shorter and Qmax-IPSS improved better, compared with non-pressure group B2, the pressure group A2 can be used to remove prostate tissue more safely, the quality of prostatectomy is more, and the time of urine color conversion is shorter after operation. The results suggest that the treatment effect of the manometry group is better than that of the non-manometry group. Conclusion the self-made bladder pressure-warning system can detect intravesical high pressure in TURP in time, deal with the causes of high pressure in time, keep low pressure irrigation for TURP all the time, prolong the safe operation time and increase the rate of tissue resection. The incidence of electrocution syndrome was significantly reduced, and TURP was more safe.
【作者单位】：浙江大学附属邵逸夫医院武义分院泌尿外科;浙江大学附属邵逸夫医院泌尿外科;
【基金】：浙江省金华市科技项目(No:2014A33400)
【分类号】：R699.8

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