经尿道前列腺电切术和汽化电切术中及术后出血原因探讨

目的探讨经尿道前列腺电切术和汽化电切术中及术后出血的原因及预防措施。方法回顾分析1999年12月-2005年6月我院18例经尿道前列腺电切和汽化电切术发生术中及术后大出血的临床资料。结果手术开展初期3例因术中出血多手术野不清，中转开放手术。3例术后24—48h因膀胱痉挛出血量大，电切镜下止血。1例出院后第5天，因大便干燥用力排便后出血；1例出院后第8天因骑车后出现出血，出血量较大，此2例均电切镜下止血。10例出院后2-10d出现肉眼血尿，膀胱腔内置三腔尿管气囊压迫止血。结论经尿道前列腺电切术和汽化电切术术中及术后并发症多发生于初期开展学习曲线内，对于容易造成术中术后出血的内科疾病，术前要有充分的认识，并给予相应处理。     

经尿道前列腺电切术后出血原因分析及处理

目的探讨经尿道前列腺电切术(TURP)后出血的原因及处理方法。方法对行TURP术的316例患者的临床资料进行回顾性分析。结果316例患者中,28例术后出血,其中术后早期出血23例,迟发性出血5例;26例经保守治疗治愈,2例经电切镜止血。结论术中确切止血及术后引流通畅是预防TURP术后出血的关键;术后及时发现出血并正确处理可避免再次手术,对膀胱内充满血块不能吸出者电切镜下止血是一种安全有效的方法。     

前列腺切除术后出血原因分析及临床对策

目的 探讨良性前列腺增生症前列腺切除术后出血原因及临床防治对策。方法2000年3月至2005年5月共有252例前列腺切除术患者，其中耻骨上前列腺切除术70例，经尿道前列腺电切术150例，汽化电切术32例。结果 术后继发出血18例，其中耻骨上前列腺切除术5例，占该组7．2％；经尿道前列腺电切术12例，占该组8．0％；汽化电切术1例，占该组3．2％。术后24h内出血见于前列腺切除创面渗血、静脉窦破裂出血、膀胱无抑制性收缩、电切综合征、导尿管球囊移位或破裂、凝血机制障碍等；远期出血见于电切创面焦痂脱落、剧烈活动、前列腺切除创面感染等。18例全部治愈，无再次继发出血。结论 术前严格掌握手术适应证，术中规范操作及严密止血，术后准确判断出血原因及积极治疗，对前列腺切除术后出血的防治有重要意义。     

经尿道前列腺电切术后出血原因及防治研究

目的探讨经尿道前列腺电切术后患者出血的原因、防治方法,为临床治疗提供帮助。方法回顾分析笔者所在医院2005年9月～2011年7月行经尿道前列腺电切术651例患者中术后出血的32例患者出血原因,根据不同的情况选择不同的治疗方案。结果术后24h出血26例,术后1～4周继发出血5例,〉4周1例;出血原因包括术前因素、术中因素、术后因素3个方面;24例患者经加大冲洗速度、加入去甲肾上腺素冲洗、静脉及肌肉应用止血药物、调整牵引力度后治愈,8例通过电切镜下再次止血处理后治愈,未改开放手术止血。结论经尿道前列腺电切术后出血的原因是多方面的,全面的术前分析、准确的术中及术后处理是减少TURP出血的关键。     

经尿道前列腺电切术后出血再手术原因分析及防治

目的探讨经尿道前列腺电切术后出血的原因及预防措施。方法回顾分析2002年1月至2011年5月本院74例经尿道前列腺电切术后大出血的临床资料。结果其中43例经保守治疗有效,31例术后出血比较严重,行再次手术止血,发现膀胱颈口出血6例,前列腺窝出血25例;动脉出血23例,静脉出血7例,创面广泛渗血1例。经再次手术以及术后适当的措施治疗,均未再出血。结论经尿道前列腺电切术后出血原因是多方面的,术前、术中、术后及时准确处理是减少术后出血的关键。     

碘伏纱带填塞前列腺窝处理前列腺术后大出血3例报告

目的:探讨前列腺术后大出血的处理方法。方法:应用碘伏纱带填塞前列腺窝止血。结果:3例前列腺术后大出血患者经碘伏纱带填塞前列腺窝后出血停止,手术时间20～30min,术后不再出血。结论:本法处理前列腺术后大出血方法简便,止血效果较好,安全无副作用,在常规止血方法无法止血时可考虑使用此方法。     

经膀胱前列腺摘除术出血的处理

目的探讨经膀胱前列腺摘除术出血的处理方法。方法回顾性分析20例经膀胱前列腺摘除术出血患者的临床资料。结果 20例经膀胱前列腺切除术出血患者经手术缝扎止血、药物止血、膀胱冲洗止血等治疗后痊愈,经回访没有再次出血。结论经膀胱前列腺摘除术后出血是此类手术的常见并发症,采取必要的处理措施对预后至关重要。     

外科引流在肝切除术中的应用价值：附145例报告

目的：探讨外科引流在肝切除术中的临床价值。方法：行肝切除术１４５例，术中常规于膈下和（或）肝下放置多侧孔血浆管，术后经血浆引流管观察出血、胆漏、感染情况。结果：①术后早期大出血３例，再次手术后止血１例，死亡２例；②发现胆漏４例，引流１～３个月自愈３例，１例死于感染及衰竭；③并发膈下感染４例，１例经局部冲洗及引流后治愈，３例再次手术（其中１例死于术后衰竭）。结论：外科引流技术对肝切除术后大出血、胆漏、感染的防治均具有重要临床意义。     

前列腺电汽化术后再出血16例原因分析

目的探讨经尿道前列腺汽化电切术(TUVP)后出血的原因和方法。方法对16例前列腺增生(BPH)患者TUVP术后再出血原因分析并进行治疗。结果14例病人经一般治疗后缓解,2例病人于电切镜下再次止血。结论术前采取预防措施,术后针对不同的病因,采取相应的治疗方法,可减少术后再出血的发生。     

前列腺增生经尿道电切术近期出血的原因和处理

目的探讨经尿道前列腺电切术（TURP）治疗前列腺增生术后近期出血的原因与处理方法。方法对本院12年来前列腺增生经尿道电切术后近期出血的52例患者进行回顾分析其原因及止血方法。结果出血的原因主要有患者高龄、高危等和在治疗中处理失当等。41例经保守治疗而好转,11例经保守治疗无效,麻醉后重新置入电切镜,冲洗血凝块,充分电凝、止血后好转。结论全面的术前分析、准确的术中和术后处理,是减少前列腺增生患者TURP术后出血的关键。     

Major complications after open prostatectomy: management and prevention]

From Jan. 1976 to Dec. 1989, 829 patients with benign prostatic hyperplasia (BPH) were treated. Open prostatectomy was performed successfully in 571 patients. Secondary hemorrhage was observed in 21 patients (3.7%), bladder neck or posterior urethral stricture in 10 (1.7%), and temporary incontinence in 21 (3.7%). No operative mortality was noted. The pathogenesis, management and prevention of those complications were detailed with review of the literatures. Effective hemostasis, proper enucleation of the enlarged gland and meticulous reconstruction of the bladder neck are claimed to be the key points in reducing complications and increasing cure rate in the treatment of BPH with open prostatectomy.     

改良的Madigan前列腺切除术的临床疗效

目的 探讨改良的Madigan前列腺切除术的疗效。方法 对2001年9月～2006年9月42例前列腺增生患者行改良的Madigan前列腺切除术的临床资料进地回顾性分析。结果 本组手术均成功。恢复均顺利。平均手术时间80min，平均出血量120ml，均未输血，平均切除前列腺组织重量78．3g。拔除导尿管后均排尿通畅。其中38例获随访，随访时间18～60个月。IPSS自术前平均29．5分下降至7．5分，残余尿≤20ml。未发现严重的 并发症，疗效满意。结论 改良的Madigan前列腺切除术为理想的良性前列腺增生症开放手术治疗方法，值得推广。     

经尿道接触式激光治疗前列腺增生216例报告

目的：探讨接触式激光治疗前列腺增生症（ＢＰＨ）的有效性。方法：１９９５年７月～１９９８年７月采用ＮＤ：ＹＡＧ接触式激光治疗ＢＰＨ２１６例。激光输出功率５０Ｗ,治疗时间５～１５ｍｉｎ。结果：随访３个月～３年,２０１例一次治疗成功,１３全钎２次激光治疗,２例改行开放性手术治愈。结论：激光手术虽然不能取代开放性手术,但其具有适应证宽、安全性高、易于掌握、患者痛苦小等优点,近期疗效肯定,易被老年患者接受。     

Laparoscopic retropubic simple prostatectomy

Purpose:Open retropubic simple prostatectomy is occasionally performed for symptomatic, large volume benign prostatic hyperplasia. We describe the technique of laparoscopic simple retropubic prostatectomy.Materials and Methods:Since August 2001 at our 2 institutions laparoscopic simple retropubic prostatectomy has been performed in 17 patients with symptomatic significant prostatomegaly on transrectal ultrasonography (60 gm or greater, mean 93). Essential aspects of our 5 port technique are transverse cystotomy just proximal to the prostatovesical junction, subcapsular plane development, prostatic adenomectomy, prostatic fossa trigonization and prostatic capsule suture repair. Demographic, perioperative and outcome data were recorded.Results:Mean operative time was 156 minutes (range 85 to 380), blood loss was 516 ml (range 100 to 2,500), hospital stay was 48 hours (range 15 to 110), and Foley catheter duration was 6.3 days (range 3 to 7). Mean specimen weight on pathological examination was 72 gm (range 32 to 120). Five patients (29%) required blood transfusion. Complications occurred in 3 patients (19%), that is intraoperative hemorrhage, catheter clot obstruction and duodenal ulcer bleeding in 1 each. All patients reported complete continence during a followup period of 1 month to 2 years. Considerable improvement from baseline was noted in American Urological Association score (preoperative vs postoperative 24.5 vs 9.9) and the maximum urine flow rate (preoperative vs postoperative 7 vs 22.8 cc per minute).Conclusions:Laparoscopic simple retropubic prostatectomy for large benign prostate hyperplasia is feasible. Our initial experience is presented.     

Volume determinations by transrectal ultrasonography in patients with benign prostatic hyperplasia: Correlation with removed prostate weight

Estimation of prostate gland volume with transrectal ultrasonography (TRUS) provides important information in the evaluation of benign and malignant prostate disease. We evaluated 119 patients with clinically benign prostatic hyperplasia (BPH) by TRUS. Sixty-eight of these underwent transurethral resection of the prostate (TUR-P), and 51 patients underwent open prostatectomy. In both groups the estimated weight correlated well with the removed prostatic weight (r=0.643, p<0.0001 in TUR-P and r=0.729, p<0.0001 in open prostatectomy). We found that TRUS is a valuable method for estimation of prostatic volume in patients with BPH.     

Madigan前列腺切除术

目的：总结Ｍａｄｉｇａｎ前列腺切除术治疗前列腺增生症（ＢＰＨ）的经验。方法：回顾性分析２６例ＢＰＨ患者的临床资料。结果：２１例尿道完整,２例膀胱颈和５例尿道损伤后均缝合修复。术后随访３－２５个月,无尿道狭窄,,尿失禁,性功能丧失等并发症。结论;本术式适应证为以侧叶增生为主,中叶无明显增生,无膀胱内疾病,未接受过射频,微波,注射及电切等治疗的ＢＰＨ患者。     

Intraprostatic spiral during waiting time for transurethral prostatectomy.

When benign prostatic hyperplasia results in voiding problems such as acute or chronic urinary retention, transurethral prostatectomy is often necessary. We have evaluated 24 patients, treated with an intraprostatic spiral, during waiting time for transurethral prostatectomy. The spiral treatment was a success in 21 patients. Three patients had a transurethral prostatectomy before scheduled time due to spiral failure, 2 with urinary retention, 1 with severe local discomfort. We conclude that spiral treatment of symptomatic benign prostatic hyperplasia while waiting for transurethral prostatectomy has a high success rate and is recommended as a favorable alternative to an indwelling urethral catheter.     

良性前列腺增生术后前列腺癌

目的 :提高对前列腺增生术后前列腺癌的认识。　方法 :回顾总结 1 2例 (年龄 6 3～ 82岁 )前列腺增生术后前列腺癌患者的临床资料。前列腺增生术后 1 0个月～ 1 4年 ,平均 5 .6年 ,发现前列腺癌。患者因排尿困难、血尿、疼痛而再次就诊。发现前列腺特异抗原 (PSA)异常 1 1例 ,前列腺结节 8例。B期 3例、C期 3例、D期 6例。 1 2例均行睾丸切除术 ,其中 1 0例加用雄激素受体阻断剂 ,3例行经尿道前列腺切除术 (TURP)。　结果 :随访 4个月～ 8年 ,平均 4 .5年。死亡 3例 ,病变稳定 6例 ,2例病变进展。　结论 :前列腺增生手术不能预防前列腺癌的发生 ,血清PSA和直肠指检是前列腺增生术后前列腺癌诊断的主要方法     

Complications and early postoperative outcome after open prostatectomy in patients with benign prostatic enlargement: results of a prospective multicenter study

PURPOSE: We prospectively analyzed the complications and immediate postoperative outcome of open prostatectomy for benign prostatic hyperplasia to provide reference data for emerging techniques, such as holmium laser enucleation of the prostate and laparoscopic prostatectomy. MATERIALS AND METHODS: A total of 902 patients with a mean +/- 1 SD age of 71.3 +/- 6.8 years were evaluated while undergoing open prostatectomy in Bavaria, Germany from January 1, 2002 to December 31, 2003. We prospectively analyzed 54 parameters concerning preoperative status, surgical details, complications and immediate outcome. RESULTS: Mean operative time was 80.8 +/- 34.2 minutes. Mean prostate size was 96.3 +/- 37.4 ml. Average enucleated tissue was 84.8 +/- 44.0 gm. Incidental carcinoma of the prostate was found in 28 of 902 patients (3.1%) and the mortality rate was 0.2%. The overall complication rate was 17.3%. The most relevant complications were bleeding requiring transfusion in 68 cases (7.5%), urinary tract infection in 46 (5.1%) and surgical revision due to severe bleeding in 33 (3.7%). Patients had an average International Prostate Symptom Score of 20.7 +/- 7.6 preoperatively. Mean urinary peak flow rate increased significantly to 23.1 +/- 10.5 ml per second from a baseline of 10.6 +/- 6.4 ml per second (p <0.0001). Post-void residual volume decreased to 17.5 +/- 34.8 ml from a baseline of 145.1 +/- 152.8 ml (p <0.0001). CONCLUSIONS: Open prostatectomy showed a satisfactory early postoperative outcome with a complication rate that was within the expected range compared to that in the recent literature. It represents an important option in the treatment of patients with significant benign enlargement of the prostate for surgeons with no access to modern techniques, such as holmium laser enucleation of the prostate or laparoscopy.     

Detection and staging of prostatic carcinoma after transurethral resection or open enucleation of the prostate: accuracy of magnetic resonance imaging.

A total of 17 patients who had undergone transurethral (16) or open (1) enucleation of the prostate for presumed benign prostatic hyperplasia had prostatic adenocarcinoma: 10 on the basis of examination of the resected specimen (stage A) and 7 upon rectal examination performed 2 to 120 months after prostatectomy for benign prostatic hyperplasia (stage B). In all patients magnetic resonance imaging (MRI) of the prostate was performed before radical retropubic prostatectomy. Preoperative imaging was compared to pathological findings with respect to the presence, location and stage of singular or multiple prostatic carcinomas. Carcinomas were categorized according to the location within the prostate: whether on the right or left side, and whether in the peripheral zone (anterior, anterolateral or posterior) or the transition zone. The sensitivity of tumor detection for cancers originating in the peripheral zone was 81%. However, the sensitivity of detection decreased to 0% for tumors confined to the transition zone. Tumor staging was not compromised by previous prostatic enucleation or transurethral resection. MRI correctly identifies carcinomas originating in the peripheral zone but cannot detect those confined to the transition zone.