商环包皮环切术与传统包皮环切术治疗包皮过长或包茎的Meta分析

目的:应用Meta分析评价商环包皮环切术与传统包皮环切术临床疗效和安全性。方法:检索国内外有关比较商环和传统手术用于治疗包皮过长或包茎的随机对照试验,由2名评价员独立按Cochrane系统评价方法对文献进行质量评价和提取资料后,采用RevMan 5.0统计软件进行Meta分析。结果:共纳入8个随机对照试验,2 277例患者。结果显示,与传统手术相比,商环包皮环切手术具有手术时间短[SMD=-5.82,95%CI(-7.39,-4.24),P<0.000 01]、术中出血量少[SMD=-3.28,95%CI(-3.47,-3.09),P<0.000 01]、创口感染率低[OR=0.44,95%CI(0.26,0.72),P=0.001]、术后出血发生率低[OR=0.05,95%CI(0.02,0.12),P<0.000 01]、术后患者对包皮外观满意率高[OR=12.72,95%CI(1.30,124.56),P=0.03]的优点,同时可以减轻患者术中疼痛[SMD=-3.32,95%CI(-3.50,-3.14),P<0.000 01]及术后24 h疼痛[SMD=-2.73,95%CI(-3.02,-2.43),P<0.000 01];但延长了患者创口的愈合时间[SMD=1.46,95%CI(1.03,1.90),P<0.000 01]。结论:商环包皮环切术具有手术时间短、并发症少、疼痛轻、术后包皮外观满意率高等优点,由于纳入文献的较少,需要更多大样本的随机对照试验进一步证实。     

经尿道激光和传统电切手术治疗非肌层浸润型膀胱肿瘤的Meta分析

目的分析和对比经尿道激光和传统电切手术治疗非肌层浸润型膀胱肿瘤的有效性和安全性,为临床决策提供依据。方法计算机检索Google、Embase、Pubmed、Web of Science和Cochrane Library等国外数据库相关英文文献,纳入相关随机对照试验和临床观察性研究文献。采用Revman5.3软件进行Meta分析,分别评价手术时间、尿管留置时间、住院时间、膀胱穿孔、闭孔神经反射、尿道狭窄和肿瘤复发等指标。结果纳入相关文献10篇(经尿道激光手术610例,经尿道膀胱肿瘤电切术667例)。Meta分析结果显示,两者在手术时间、术后尿道狭窄及肿瘤复发率上无差异,但激光手术组术后留置尿管(P=0.0001,95%CI:-1.58~-0.51)和住院时间(P=0.000 1,95%CI:-1.58~-0.51)显著缩短,术中膀胱穿孔(P=0.000 5,OR=0.14,95%CI:0.04~0.42)、闭孔神经反射(P0.000 01,OR=0.04,95%CI:0.01~0.12)和术后膀胱刺激征(P0.000 01,OR=0.14,95%CI:0.08~0.24)显著减少。结论经尿道激光手术治疗非肌层浸润型膀胱肿瘤在围手术期安全性及术后恢复速度方面均优于传统电切,但两者在肿瘤预后和手术时间方面相似。然而,这一结论尚需大规模、多中心的临床随机对照试验来进一步验证。     

经尿道双极等离子电切系统治疗膀胱癌85例报告

目的探讨应用经尿道双极等离子电切系统治疗膀胱癌的安全性和疗效。方法采用英国Gyrus公司的经尿道双极等离子电切系统行经尿道膀胱肿瘤电切术(transurethral resection of the bladder tumor,TURBT)治疗膀胱癌85例,切割电极切除肿瘤直达深肌层,同时扩大到电切距肿瘤基底1 cm范围的正常组织,术后定期膀胱内灌注吡柔比星。结果手术时间10~52 min,平均23 min。术中发生闭孔神经反射19例,其中腹膜外穿孔2例。64例随访3~72个月,平均21个月,复发17例(术后6~12个月3例复发,1~2年9例复发,2~5年5例复发),行1~4次电切8例,膀胱部分切除5例,全膀胱切除4例;死亡2例,其中1例死于心机梗死,另1例死于肿瘤广泛转移。结论双极等离子电切系统行TURBT治疗浅表性膀胱癌是一种安全有效的方法,但仍要防止闭孔神经反射的发生。     

经尿道双极等离子体电切术治疗膀胱肿瘤的疗效观察

目的:探讨经尿道双极等离子体电切术治疗膀胱肿瘤的安全性与有效性。方法:采用英国Gyrus公司的经尿道双极等离子体电切系统行经尿道膀胱肿瘤电切术(TURBt)治疗膀胱肿瘤271例,患者年龄18～90岁,平均63.6岁。其中单发肿瘤160例,多发肿瘤111例,膀胱侧壁有肿瘤分布者96例。结果:首次诊断为膀胱肿瘤行经尿道双极电切术的时间为46±21(15～75)min,膀胱穿孔21例;96例侧壁肿瘤切除时出现明显的闭孔神经反射56例。随访6～72个月,复发149例,其中再次行电切术102例,行部分膀胱切除加输尿管移植术24例,行全膀胱切除术20例。结论:用双极等离子体电切术治疗膀胱肿瘤是一种安全、有效的手术方式,但不能防止闭孔神经反射的发生。     

经尿道等离子双极电切术治疗膀胱白斑

目的探讨经尿道等离子双极电切术治疗膀胱白斑的疗效。方法回顾性分析11例经尿道等离子双极电切术治疗的膀胱白斑患者的临床资料。结杲11例均行经尿道等离子双极电切术治疗、术后膀胱灌注化疗，随访4—12个月，平均8个月，其中治愈11例，均未见复发。结论经尿道等离子双极电切术是治疗膀胱白斑的可靠方法，可作为替代尿道电切术的新术式。     

超声引导下闭孔神经阻滞在经尿道膀胱肿瘤电切术中预防闭孔神经反射的效果

目的通过对比不同麻醉方式下闭孔神经反射的发生情况,探讨经尿道膀胱肿瘤电切术中预防闭孔神经反射的有效方式。方法选取需行经尿道膀胱肿瘤电切术的膀胱侧壁肿瘤患者160例,男134例,女26例,ASAⅠ~Ⅲ级,随机分为四组:全凭静脉麻醉组(G组),腰-硬联合麻醉组(C组),腰-硬联合麻醉复合静脉麻醉组(V组),腰-硬联合麻醉复合闭孔神经阻滞(obturator nerve block,ONB)组(O组),每组40例。记录不同麻醉方式下闭孔神经反射的发生情况。结果O组闭孔神经反射发生率(7.5%)明显低于C组(32.5%,P=0.005)和V组(40.0%,P=0.001),与G组闭孔神经反射发生率(5.0%)差异无统计学意义(P=0.644)。结论腰-硬联合麻醉复合闭孔神经阻滞与全凭静脉麻醉均可有效预防闭孔神经反射的发生。     

经尿道双极电切术治疗浅表膀胱肿瘤

目的　探讨经尿道双极电切术治疗浅表膀胱肿瘤 (双极TURBt)的安全性与有效性。方法　用英国Gyrus公司的经尿道双极电切系统行浅表膀胱肿瘤切除术 2 6例。多发肿瘤 8例 ,单发肿瘤 18例 ,膀胱侧壁有肿瘤分布者 13例。结果　经尿道膀胱肿瘤双极电切术手术时间 (19±10 )min(8～ 3 5min) ,无TUR综合征 ,无一例膀胱穿孔 ;13例侧壁肿瘤切除均无明显闭孔神经反射 ,随访 1～ 6个月无复发。结论　用双极电切进行TURBt是一种安全、有效的手术方式     

非麻醉下经尿道等离子电切术治疗浅表膀胱癌9例报道

目的:评价非麻醉下应用经尿道等离子电切术治疗浅表膀胱癌的可行性.方法:应用经尿道等离子电切术治疗浅表膀胱肿瘤,肿瘤直径<1 cm,不超过2个.结果:9例手术均成功,平均手术时间10 min,术中未出现闭孔神经反射、膀胱穿孔、大出血等并发症.结论:非麻醉下经尿道等离子电切术具有创伤小,时间短,恢复快,并发症少,费用低,安全有效等优点,适用于门诊推广.     

单极和双极技术在经尿道膀胱肿瘤电切术中有效性和安全性比较的Meta分析

目的通过荟萃分析比较双极经尿道膀胱肿瘤电切术(bTURBT)与单极经尿道膀胱肿瘤切除术(mTURBT)的有效性和安全性。方法 2019年5月在PubMed、Medline、Embase和Cochrane图书馆数据库检索,并用所得数据进行随机对照试验(RCTs)的配对荟萃分析。结果共有9个随机对照试验,1 879名患者(889名mTURBT患者和990名bTURBT患者)被纳入本次荟萃分析。研究发现,在血红蛋白水平(WMD=-0.32,95%CI:-0.60～-0.04,P=0.027)和钠水平(WMD=-0.83,95%CI:-1.06～-0.60,P0.001)方面,bTURBT优于mTURBT。2种术式在闭孔神经反射、膀胱穿孔、输血、血栓潴留、电切综合征、切除时间、置管时间、术后停留时间、无复发生存率等方面无显著性差异。然而,bTURBT为组织样本提供了明显较低的烧灼伪影(OR=0.32,95%CI:0.18～0.56,P0.001)。结论单极和双极技术在疗效和安全性方面并没有显著的差异。但是bTURBT保留了更好的组织,这意味着在经尿道膀胱肿瘤切除术中热损伤率较低,能够为病理科医生提供更好的病理组织。     

膀胱穿刺造瘘辅助行经尿道双极等离子前列腺电切术的临床观察

目的探讨膀胱造瘘辅助行经尿道双极等离子前列腺电切术治疗合并尿道狭窄的前列腺增生的效果。方法回顾性研究2011年5月~2016年4月本院诊治的438例前列腺增生症患者,其中有412例患者行经传统的尿道双极等离子前列腺电切术,26例合并尿道狭窄患者中。26例合并有尿道狭窄中19例采用膀胱穿刺造瘘辅助下经尿道双极等离子前列腺电切除治疗除,另7例由于严重尿道狭窄未实施手术治疗。将19例采用膀胱穿刺造瘘辅助下前列腺电切患者作为观察对象,另选择19例传统经尿道前列腺电切患者作为对照组,分析两组手术效果。结果观察组患者电切手术时间110.34±10.46 min,术中出血量80.34±6.12 m L,二者均高于传统的经尿道电切术,两组间差异有统计学意义。两组在切除前列腺组织、术后冲洗膀胱时间、术后膀胱残余尿量、前列腺症状评分方面的差异均没有统计学意义。结论经尿道等离子前列腺电切术联合膀胱穿刺造瘘术治疗合并尿道狭窄的前列腺增生患者的手术时间及术中出血量有所增加,但手术总体效果良好,并发症没有增加。     

PlasmaKinetic Superpulse transurethral resection versus conventional transurethral resection of prostate

PURPOSE: To compare the efficacy and safety of the PlasmaKinetic (PK) Superpulse system with that of conventional transurethral resection of the prostate (TURP) in terms of restoration of urinary flow and early postoperative course. PATIENTS AND METHODS: One hundred five men older than 45 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia (BPH) were randomized, 51 undergoing standard TURP with glycine as the irrigation fluid and 53 TURP with the PK Superpulse system with normal saline as irrigant. The operative time, intraoperative blood loss, catheter time, change in serum electrolytes (particularly sodium), and uroflowmetry and American Urological Association (AUA) Symptom Scores were compared. RESULTS: The blood loss as well as the catheter time observed in the PK Superpulse arm were significantly less than those in the conventional-TURP arm. The mortality rate was 0 in both the arms. The mean operative time was less in the PK Superpulse arm, although not significantly so. Hyponatremia was statistically insignificant. Significant changes were observed in the AUA Scores in both arms. CONCLUSION: The PK Superpulse system provides faster removal of tissue in a bloodless field with better views and a safer environment of saline irrigation with efficacy comparable to that of conventional TURP. However, further randomized trials with extended follow-up may be needed to better define the role of the PK Superpulse system in treating patients with symptomatic BPH.     

Glycine and transurethral resection

Fifty patients undergoing transurethral resection of the prostate were studied for evidence of glycine absorption and haemodilution. Plasma glycine levels increased substantially in nine patients and, in five, calculated irrigant fluid absorption ranged from 619-1582 ml; another patient had absorbed 1360 ml fluid with only a small rise in plasma glycine. Two illustrative case histories are presented. The role of glycine as an inhibitory neurotransmitter is discussed and the possibility of toxic mechanisms other than dilutional hyponatraemia is mentioned. Intravenous diuretics, hypertonic saline, and perhaps calcium salts, are recommended for the overt transurethral resection syndrome.     

The transurethral resection syndrome

The transurethral resection syndrome ("TUR syndrome") is caused by absorption of electrolyte-free irrigating fluid, and consists of symptoms from the circulatory and nervous systems. The clinical picture is inconsistent and the syndrome is easily confused with other acute disorders. Mild forms are common and often go undiagnosed, while severe forms of the TUR syndrome are rare and potentially life-threatening. The pathophysiology is complex but includes four mechanisms: circulatory distress from the rapid absorption of electrolyte-free irrigating fluid, adverse effects of glycine, dilution of the protein and electrolyte concentrations of the body fluids, and disturbance of renal function. The treatment of the TUR syndrome consists of general life support and in specific treatment directed towards hypotension, hyponatraemia and anuria. Methods to lower the uptake of irrigating fluid are widely used and probably reduce the incidence of the TUR syndrome. However, patient safety can be guaranteed only if the absorption is monitored. An irrigating fluid containing tracer amounts of ethanol can be used for this purpose. This permits the uptake of fluid to be indicated by measuring the concentration of ethanol in the patient's exhaled breath.     

经尿道电切术的内毒素血症

１９９３年１－８月测定４３例经尿道电切术患者术前、术中血内毒素浓度变化，探讨ＴＵＲ内毒素血症与临床意义。患者男性３９例，女性４例。其中良性前列腺增生１７例，ＢＴＣＣ１９例，膀胱颈口梗塞７例，年龄１７－７５岁，平均５７．１岁。随机选择分为两组，Ⅰ组２１例，仅口服抗生素；Ⅱ组２２例，静脉滴注先锋霉素Ⅵ２ｇ后方实施ＴＵＲ。     

经尿道前列腺等离子双极电切术与普通电切术中失血量比较

目的比较经尿道前列腺等离子双极电切术与普通电切术中失血量。方法自2007年10月至2008年3月,收治的30例BPH患者行经尿道等离子双极电切（PKRP）;自2008年4月至7月,收治的30例BPH患者行普通电切（TURP）。分析这60例患者的临床资料。PKRP组年龄（74．2±7．0）岁,前列腺体积（49．3±33．1）ml;TURP组年龄（73．2±7．2）岁,前列腺体积（51．1±23．2）ml。收集术中所有冲洗液,测冲洗液体积,混匀后精确测血红蛋白浓度。结果PKRP组手术时间（111．3±42．5）min,切除前列腺组织重量（20．1±14．3）g,失血量（86．3±79．9）ml,每克前列腺组织平均失血量（3．7±1．9）ml／g;TURP组手术时间（108．0±42．2）min,切除前列腺组织重量（23．6±13．1）g,失血量（201．8±178．7）ml,每克前列腺组织平均失血量（8．3±6．1）ml／g。PKRP组和TURP组手术时间及切除前列腺组织重量差异无统计学意义（P〉0．05）。PKRP组术中失血量少于TURP组（P〈0．01）。PKRP组每克前列腺组织平均失血量少于TURP组（P〈0．01）。结论经尿道前列腺等离子双极电切术中失血量少于普通电协。     

Prophylactic cefuroxime in transurethral resection

Summary 65 men undergoing elective transurethral resection of the prostate under the care of one urologist entered a randomised controlled trial using Cefuroxime. Patients were excluded if they had received antibiotics in a 2 week period before surgery, if they had positive pre-operative urine cultures or if they had been catheterised. 58 patients completed the study. One patient in the antibiotic group and 2 in the control group developed urinary infection. The overall infection rate was 5.17%. The control and antibiotic groups were comparable as regards age and the duraction of resection. One patient in the antibiotic group developed an allergic reaction. It is felt that routine antibiotic prophylaxis in patients with sterile urine undergoing elective TUR is unnecessary.