耻骨上前列腺切除术并发症的预防措施及效果观察

目的:探讨耻骨上前列腺切除术常见并发症的防治方法。方法:紧贴前列腺尖部捻断尿道,摘除前列腺后,采用腺窝口5、7点处“8”字缝合,后唇及三角区黏膜下U字型沟槽状切除,将后唇黏膜缝入腺窝内的外科包膜上;术后3d应用硬膜外腔接微量止痛泵持续注入吗啡、布比卡因、氟哌啶混合液1mL/h止痛。结果:采用以上方法经治54例,除2例硬膜外导管脱出,1例止痛泵接点漏液外,51例术后无疼痛及膀胱痉挛。拔除导管后4例出现一过性尿失禁;45例随访3个月～2年;40例排尿通畅,5例排尿困难,其中腺体残留2例,尿道口狭窄2例,后尿道狭窄1例。结论:采用耻骨上前列腺切除可有效防止术后并发症的发生。     

耻骨上前列腺切除术并发症及预防

我院1978～1995年进行前列腺肥大手术47例，其中行前列腺切除术32例，膀既造接术15例，现就耻骨上前列腺切除术并发症及预防讨论如下。116床资料1．l一般资料：47例中，年龄sl～60岁4例，61～70岁11例，71～80岁17例，其中61～80岁占87．5％，平均年龄69．9岁。1．2手术方法：本组行耻骨上前列腺切除32例。进膀俄后用手指剜除前列腺后．用热盐水纱布压迫后用毗福尔马林压迫止血，常规于腺窝5点、7点处肠线缝扎，其余视出血情况缝扎或缝扎一圈，从前尿道插入Foley导尿管，气囊充水30ml置人膀眈内，并稍加牵拉固定于大腿处，以隔绝腺窝及膀眈…     

耻骨上前列腺切除术后排尿困难原因分析

目的 分析耻骨上前列腺切除术后排尿困难的原因,为防治提供依据。方法 回顾性分析32例前列腺增生行耻骨上前列腺切除术后出现排尿困难病例的临床资料。结果 32例患者中,膀胱颈狭窄8例,膀胱 后唇过高7例,膀胱窝口缝扎过紧5例,腺体残留4例,尿道狭窄及假道形成4例,膀胱功能障碍3例,前列腺窝异物并结石1例。结论 耻骨上前列腺切除术后排尿困难原因多为手术操作不当及术前术后处理欠佳所致,其预防及处理措施应根据不同情况决定。     

等离子前列腺汽化切除术的并发症观察及护理

目的 探讨等离子前列腺汽化切除术的并发症及护理。方法 86例前列腺增生症的患者在连续硬膜外麻醉下使用Gyrus公司等离子发生器实施了等离子前列腺汽化切除术。结果 本组常见的并发症分别为：出血6，9％（6／86），膀胱痉挛15．1％（13／86），暂时性尿失禁9，3％（8／86），永久性尿失禁1，16％（1／86），排尿不畅和尿道狭窄4，65％（4／86）。结论 术后良好的护理有利于患者的恢复。     

耻骨上经膀胱前列腺切除术常见并发症的防治

目的探讨耻骨上经膀胱前列腺切除术常见并发症的原因及防治方法。方法分析我院1993年1月至2009年12月耻骨上经膀胱前列腺切除术治疗前列腺增生症566例患者的病历资料。结果发生术后大出血4例(0.7%),术后尿失禁13例(2.3%),排尿困难6例(1.1%)。经采用综合防治措施全部治愈。结论围术期管理及手术操作是避免或减少并发症的关键。     

经耻骨后保留尿道前列腺切除术的体会

我院自 1 999～ 2 0 0 0年采用经耻骨后保留尿道前列腺切除术即ｍａｄｉｇａｎ手术 ,治疗前列腺增生症患者1 0例 ,疗效满意 ,体会如下。1　临床资料1 1　一般资料　本组共 1 0例 ,平均年龄 68岁。均有典型的前列腺增生症状和反复发作尿潴留病史 ,经Ｂ超检测膀胱剩余尿为 50～ 60ｍｌ,肛门指检中间沟消失。合并膀胱结石 2例 ,泌尿系感染 6例 ,高血压或冠心病 3例。1 2　方法 　麻醉后平卧位 ,臀部垫高 ,消毒铺巾后 ,尿道插入Ｆ1 8～ 2 0号三腔单气囊导尿管 ,囊内注生理盐水 1 5～ 2 0ｍｌ,取下腹正中切口 ,逐层切开并暴露膀胱及前列腺包膜 …     

机器人辅助腹腔镜下耻骨上前列腺切除术

目的 探讨机器人辅助腹腔镜下耻骨上前列腺切除术治疗良性前列腺增生(BPH)的临床疗效.方法 应用ZEUS机器人AESOP(USA)操作臂持镜机器人腹腔镜下耻骨上前列腺切除治疗BPH患者21例.前列腺平均体积90(68～160)mL,平均剩余尿110(60～300)mL.合并膀胱结石11例.结果 21例手术均获成功.手术时间90(90～210)min,平均130min;出血量70～420mL,平均210mL;术后膀胱冲洗2～6d,平均3.5d.住院时间4～9d,平均6.5d.手术前后最大尿流率分别为(4.10±3.43)(0～7.3)和(19.5±5.05)(15.2～26.8)mL/s.手术前后比较差异有显著性(P<0.05).21例随访4～15个月无尿失禁及尿潴留发生.结论 机器人辅助腹腔镜下耻骨上前列腺切除治疗良性前列腺增生使手术效率提高,操作更精确,手术更安全,疗效满意.     

耻骨后保留尿道前列腺切除术126例临床分析

目的探讨应用耻骨后保留尿道前列腺切除术(Madigan术)治疗前列腺增生症的疗效。方法对126例前列腺增生症患者行Madigan术；术后随访5个月～5年。结果本组126例手术顺利．术后恢复快，出血少，并发症少。结论Madigan术是治疗前列腺增生症一种较好的手术方法。     

前列腺电汽化术后并发症的观察及护理

随着我国人口老龄化,前列腺增生症(benign prostatic hyperplasia,BPH)病人明显增加。对有手术适应证的病人,目前多采用经尿道前列腺电汽化术(transurethral vaporization of prostate,TUVP)和电切术相结合。术后护理应重视预防经尿道电切综合征(transurethral resection syndrome,TURS)、膀胱痉挛、继发性出血、下肢深静脉血栓形成、压疮等并发症。本文总结了病人前列腺电汽化术后并发症的观察及护理。     

良性前列腺增生症开放性手术后近期排尿困难的临床分析

目的 探讨良前列腺增生症行耻骨上经膀胱前列腺摘除术后6个月内出现排尿困难的原因、诊治及预防.方法 回顾性分析24例患者的临床资料,对其诊治和预防进行探讨.结果 21例行手术治疗,膀胱颈狭窄9例,后尿道狭窄9例,腺体残留3例.行经尿道膀胱颈切开术9例,开放性手术(膀胱颈、后尿道切开术)9例,经尿道前列腺摘除加膀胱颈后唇切开3例.3例行保守治疗,诊断为逼尿肌无力,经留置气囊导尿管1个月后缓解.随访9～90个月,6个月内无因排尿困难而再次入院者.结论 耻骨上经膀胱前列腺摘除术后再次出现排尿困难者,多于术后6个月内出现,其中大多数需要再次手术.应重视术中的操作技术和术后管理,尽量避免术后近期因排尿困难而再次手术.

Abstract：

Objective To summarize the diagnosis,treatment and prevention of dysuria within 6 months after the suprapubic transvesical prostatectomy. Methods Twenty-four cases were retrospectively reviewed,including the data on the diagnosis, treatment and prognosis. Results Twenty-one of the 24 cases had received surgery. There were 9 cases with bladder neck stricture,9 cases with posterior urethra stricture and 3 cases with of remnant glands. Nine cases received transurethral bladder neck incision, 9 received open surgery ( bladder neck,posterior urethral incision) and 3 received transurethral resection of the prostate (TURP) plus bladder neck incision. The other 3 diagnosed as detrusor weakness were conservatively treated by indwelling catheter and they were improved one months later. None of these patients was readmitted into hospital for dysuria within 6 months after treatment. Conclusion The recurrence of dysuria post prostatectomy mostly ( 75% ) occurred within 6 months after surgery. A majority of these patients need a second surgery. To avoid a second surgery for postoperative dysuria, much attention should be paid to the operating technique and postoperative management.     

综合护理干预对经尿道前列腺电切术后并发症的影响

目的探讨减少经尿道前列腺电切除术（TURP）术后并发症的有效护理干预措施。方法回顾性调查综合护理干预前（2007年1～12月）首次行TURP患者111例并作为对照组，实施综合护理干预后（2008年2月至2009年2月）首次行TURP患者143例作为观察组。将两组TURP患者术后1周、1个月并发症进行对比分析。所有资料采用SPSS11．0统计软件包进行统计处理、t检验及χ^2检验分析。结果观察组入院后第1天，心理干预后1周成人抑郁自评量表、焦虑自评量表比较差异有统计学意义（P〈0．01）；两组术后1周电切综合征、术后排尿不畅、术后1个月附睾炎3项比较差异无统计学意义（P〉0．05）；两组术后1周膀胱痉挛、下尿路感染、术后1个月继发性出血3项比较差异有统计学意义（P〈0．01）；其他各项比较，差异均有统计学意义（P〈0．05）。结论综合护理干预措施能有效减少TURP术后并发症。     

保留尿道前列腺切除术与耻骨上前列腺切除术的疗效比较

目的：比较保留尿道前列腺切除术与耻骨上前列腺切除术的临床疗效。方法：对９０例耻骨上前列腺切除术（耻骨上组）与２３例保留尿道前列除术（保留尿道组）的临床资料进行回承性分析。结果：术中两组病人的手术时间、出血量无差别;术后两组病人的肠道功能恢复时间、使用抗生素时间和发热时间无差别;但保留尿道组在持续膀胱中冲洗时间,留置导尿管时间,术后住院时间均比耻骨上组缩短,总住院费用比耻骨上组减少。结论：对于良前列     

腹腔镜前列腺癌根治术要点与技巧

前列腺癌是一种常见的男性泌尿生殖系统肿瘤,传统的外科性手术治疗仍旧是早期前列腺癌的有效治疗方法。其中腹腔镜根治性前列腺切除术已经成为前列腺外科治疗的常规方法。本文对已经开展的腹腔镜前列腺癌根治术要点及技巧结合相关文献做一综述性分析。     

解剖性耻骨后根治性前列腺切除术

虽然近年来腹腔镜手术及机器人辅助腹腔镜手术发展迅速,但解剖性耻骨后根治性前列腺切除术仍是治疗局限性前列腺癌的金标准。经过20多年的不断改进与创新,这项手术技术无论在安全性还是从有效性上都得到了很大的提高,同时也存在一定的并发症,如术中出血、直肠损伤、术后尿失禁、勃起功能障碍等。本文结合临床经验体会,对解剖性耻骨后前列腺癌根治术的要点进行详尽探讨,并对近年来手术技巧方面的改进作一简要阐述。     

前列腺切除术后尿失禁影响因素分析

目的：总结良性前列腺增生癌患者耻骨上经膀胱前列腺切除术和经尿道前列腺电切除术术后尿失禁的影响因素、预防措施及手术时机的选择。方法：将415例患者分为2组：197例行耻骨上经膀胱前列腺切除术，218例行经尿道前列腺电切除术。术前行相关尿流动力学检查，术后2组患者行1个月，6个月，12个月追踪随访。结果：80％以上的良性前列腺增生症患者术前合并膀胱功能改变，术后尿失禁患者均发生于失代偿的患者。结论：前列腺切除术后尿失禁的因素是多方面，膀胱功能障碍是其主要原因之一，通过尿流动力学检查术前评估患者的膀胱和括约肌功能，合理把握手术时机，争取在膀胱代偿期解决梗阻，可以减少术后尿失禁的发病率。     

Differences in self-reported outcomes of open prostatectomy patients and robotic prostatectomy patients in an international web-based survey

ObjectivesTo compare patient reported outcomes between robotic assisted surgery and non-robotic assisted surgery.MethodsThis was an international web-based survey based on a qualitative research and literature review, an internet-based questionnaire was developed with approximately 70 items. The questionnaire included both closed and open-ended questions.ResultsResponses were received from 193 men of whom 86 had received either open (OP) or robotic (RALP) surgery. A statistically significant (p = 0.027), ranked analysis of covariance was found demonstrating higher recent distress in the robotic (RALP) surgery group. Although not statistically significant, there was a pattern of men having robotic (RALP) surgery reporting fewer urinary and bowel problems, but having a greater rate of sexual dysfunction.ConclusionsMen who opt for robotic surgery may have higher expectations for robotic (RALP) surgery, when these expectations are not fully met they may be less likely to accept the consequences of this major cancer surgery. Information regarding surgical choice needs to be tailored to ensure that men diagnosed with prostate cancer are fully informed of not only short term surgical and physical outcomes such as erectile dysfunction and incontinence, but also of potential issues with regards to masculinity, lifestyle and sexual health.     

精准化护理对经尿道前列腺气化切除术治疗前列腺增生患者的影响

目的 观察分析精准化护理对经尿道前列腺气化切除术治疗前列腺增生患者的影响。 方法 回顾分析2016年1月至2018年12月在海安市中医院行经尿道前列腺气化切除术治疗前列腺增生的82例患者的临床护理资料，其中41例进行常规护理，为对照组；41例进行精准化护理，为观察组。对比两组患者前列腺症状的改善情况（IPSS评分）、生活质量（QOL）评分、术后并发症发生率以及护理满意度。 结果 观察组IPSS评分、QOL评分以及住院时间皆少于对照组，差异有统计学意义（P<0.05）；观察组并发症的发生率为17.07%，对照组为46.34%，差异有统计学意义（P<0.05）；观察组的护理满意度为95.12%，对照组为75.61%，差异也有统计学意义（P<0.05）。 结论 采取精准化护理，能有效促进经尿道前列腺气化切除术后患者的术后恢复，降低并发症的发生率，提高患者的生活质量以及护理满意度。     

经尿道前列腺切除术后尿失禁现象的调查与分析

目的调查和分析经尿道前列腺切除术后尿失禁现象的现状。方法对258例经尿道前列腺切除术后1月内患者进行尿失禁发生情况调查,对发生尿失禁患者用尿失禁问卷表简表调查漏尿量、漏尿频率、对日常生活影响,同时调查漏尿持续时间及术后发生尿失禁时间。结果 35例术后发生尿失禁,发生率为13.57%;35例患者在术后2~21d发生尿失禁,漏尿持续时间1~28d,尿失禁问卷表简表评分4~11分,平均(7.25±3.26)分,65.71%患者为少量漏尿,54.28%患者每天漏尿1次,65.71%患者未能到达厕所就会有尿液漏出。结论尿失禁是前列腺增生术后较常见的并发症,尿失禁以漏尿持续时间1周内、漏尿量少、漏尿频率1次/d为主,日常生活影响一般。     

Simultaneous vs staged treatment of urolithiasis in patients undergoing radical prostatectomy

AIM: To assess the outcomes of men treated for urolithiasis at the time of radical prostatectomy.METHODS: From 1991 to 2010, 22 patients were retrospectively identified who were treated simultaneously (n = 10) at radical prostatectomy, or (n = 12) within 120 d prior to prostatectomy, for urolithiasis. Clinical characteristics were reviewed including: type of prostatectomy and stone surgery, location and amount of stone burden, perioperative change in hemoglobin and creatinine, stent frequency, total hospital d, stone-free rates, additional stone procedures and complications. Long-term functional outcomes including stress urinary incontinence and bladder neck contracture were reported. Differences between cohorts (simultaneous vs staged treatment) were assessed.RESULTS: Among men undergoing radical prostatectomy, primary stone procedures included 12 ureteroscopy, 6 shock wave lithotripsy, 2 open nephrolithotomy and 2 percutaneous nephrolithotomy. In staged shock wave lithotripsy there were 4 complications and 3 additional procedures vs 1 (P = 0.5) and 0 (P = 0.2) in the simultaneous cohort. Meanwhile in staged ureteroscopy there were 5 complications and 1 additional procedure vs 1 (P = 0.2) and 1 (P = 0.9) in the simultaneous cohort. Additional procedures for residual stones was greater among patients with asymptomatic upper tract calculi 3 (60%) relative to patients with symptomatic stones 2 (13%; P = 0.02). Likewise, patients with proximal or multiple calculi had a greater total hospital days 5.5 vs 4.1 (P = 0.04), additional procedures 6 vs 0 (P = 0.04) and lower stone-free rates 39% vs 89% (P = 0.02) relative to men with distal stones. Finally, there was no difference in the incidence of bladder neck contracture (P = 0.4) or stress urinary incontinence (P = 0.7) between cohorts.CONCLUSION: Ureteroscopic treatment of symptomatic distal urolithiasis at radical prostatectomy appears to be safe and efficacious with a low rate of adverse postoperative outcomes.