牵引时间对经尿道前列腺汽化电切患者术后膀胱痉挛的影响

目的探讨经尿道前列腺汽化电切术(TUVP)术后牵引时间对膀胱痉挛(BS)的影响。方法采用目的抽样法,根据医生术后是否牵引及牵引时间不同,将115例TUVP术后患者分为三组。Ⅰ组32例,术后不予牵引;Ⅱ组51例,术后尿道外口纱布加压法牵引6 h;Ⅲ组32例,术后尿道外口纱布加压法牵引12~24 h。观察三组患者TUVP术后24 h内发生BS的情况。结果三组患者术后24 h内BS发生率差异有统计学意义(P<0.05),Ⅱ组在24 h内BS的发生率与Ⅲ组有显著差异显著(P<0.0125)。结论 TUVP术后导尿管牵引6 h能有效降低BS的发生率。     

间苯三酚防治经尿道前列腺电切术后膀胱痉挛的疗效及安全性

目的 探讨间苯三酚用于防治经尿道前列腺电切术（TURP）后膀胱痉挛的临床疗效及安全性.方法 将46例TURP术后患者随机分为观察组24例和对照组22例.手术当日起,观察组静滴间苯三酚80 mg/次,2次/d;对照组口服索利那新5 mg/次,1次/d;两组均用药至术后拔除尿管.比较两组TURP术后72 h每天膀胱痉挛发作次数、持续膀胱冲洗时间、冲洗液转清时间、留置导尿管时间.结果 观察组术后24h内、24 ～48 h、＞48 ～72 h膀胱痉挛发生次数与对照组比较均无统计学差异（P均＞0.05）.观察组术后持续膀胱冲洗时间、冲洗液转清时间、留置导尿管时间均长于对照组（P均＜0.05）.观察组未发生药物不良反应事件,对照组发生药物不良反应事件5例,两组不良反应发生率有统计学差异（P＜0.05）.结论 间苯三酚防治TURP术后膀胱痉挛的疗效与索利那新相当,但不良反应发生率低,安全性更高.     

经尿道前列腺电切术后护理体会

经尿道前列腺电切术，是近年来在治疗前列腺增生症方面的重大进展，与其他手术治疗措施相比较具有痛苦小、操作简便等优点。1999—11／2004—04，我们做此手术256例，现将护理体会报告如下。     

索利那新预防经尿道等离子前列腺剜除术与电切术后膀胱痉挛的临床疗效观察

目的观察术后应用索利那新预防经尿道等离子前列腺剜除术与电切术后膀胱痉挛的临床疗效。方法将120例接受手术治疗的前列腺增生患者随机分为4组,每组30例。A组只接受经尿道等离子前列腺剜除术治疗;B组接受经尿道等离子前列腺剜除术后当日口服索利那新5 mg/次、2次/d,连续服用3 d;C组只接受经尿道前列腺电切术治疗;D组接受经尿道前列腺电切术后服用索那利新5 mg/次、2次/d,连续服用3 d。观察各组术后住院时间、导尿管留置时间、膀胱冲洗液转清时间、膀胱痉挛次数和持续时间、疼痛视觉模拟评分。结果 B组导尿管留置时间和膀胱冲洗液转清时间显著低于A组,D组导尿管留置时间和膀胱冲洗液转清时间显著低于C组(P0.05);B组术后膀胱痉挛次数和持续时间、疼痛视觉模拟评分显著低于A组;D组术后膀胱痉挛次数和持续时间、疼痛视觉模拟评分显著低于C组(P0.01);B组和D组均有较轻的药物不良反应发生,总不良反应发生率比较差异无统计学意义(P0.05)。结论索利那新可有效预防经尿道等离子前列腺剜除术与电切术后膀胱痉挛,安全性好。     

经尿道前列腺等离子双极电切术与耻骨上经膀胱前列腺切除术治疗良性前列腺增生的疗效比较

目的 比较经尿道前列腺等离子双极电切术(TKRP)与耻骨上经膀胱前列腺切除术(SPP)治疗良性前列腺增生(BPH)的临床疗效和对患者性功能的影响.方法 200例BPH患者根据手术方式分为电切手术组和开放手术组,电切组给予TKRP手术治疗,开放手术组给予SPP手术治疗.观察两组手术时间、膀胱冲洗时间、尿管留置时间、术后住院时间;术后随访6个月,观察两组IPSS评分、QOL评分、最大尿流率(Qmax)以及术后并发症发生情况;术后随访12个月,观察两组性功能情况.结果 电切手术组手术时间、膀胱冲洗时间、留置导尿管时间、术后住院时间显著低于开放手术组(P＜0.01).术后电切手术组和开放手术组IPSS、QOL评分显著下降,Qmax显著上升,与术前比较均有显著性差异(P＜0.01);术后电切手术组IPSS、QOL评分及Qmax与开放手术组比较有显著性差异(P＜0.01).电切手术组术后勃起障碍、逆行射精和并发症的发生率均低于开放手术组,相比较有显著性差异(P＜0.05).结论 TKRP是治疗BPH的一种安全、有效、对患者性功能影响小的手术方法.     

经尿道前列腺电切术后综合尿道护理

目的探究经尿道前列腺电切术后综合尿道护理的应用价值。方法对我院2011年1月至2013年1月接受经尿道前列腺电切术治疗的患者进行抽样,随机选取100例患者分为对照组和观察组,各50例,对照组采取常规护理方法,观察组实行综合尿道护理干预,对比分析两组患者并发症及满意度。结果观察组患者出现并发症2例(4%),患者非常满意27例(54%),比较满意21例(42%),总满意率96%;对照组患者出现并发症10例(20%),患者非常满意15例(30%),比较满意23例(46%),总满意率76%。两组在并发症、满意度上有明显的差异,具有统计学意义(P0.05)。结论对接受经尿道前列腺电切术治疗的患者术后实行综合尿道护理,能减少患者并发症,提高患者满意度,值得进一步临床应用。     

经尿道前列腺电汽化切除术治疗中老年良性前列腺增生患者436例

良性前列腺增生(BPH)是泌尿外科一种常见的老年性疾病,多因前列腺组织良性增大引起不同程度下尿路梗阻症状而严重影响患者的日常生活质量[1].经尿道前列腺电切术(TURP)是目前临床治疗BPH的金标准,但术后并发症发生率较高.近年来,经尿道前列腺电汽化切除术(TUVP)在临床已得到广泛应用且疗效满意.     

一期经尿道浅表膀胱癌并增生前列腺切除术后肿瘤复发情况观察

47例初发浅表膀胱癌伴良性前列腺增生患者分为A、B两组。A组21例,仅行经尿道膀胱肿瘤电切术（TURBt）;B组26例,一期行经尿道膀胱肿瘤＋前列腺电切术（TURBt＋P）。两组均给予吡喃阿霉素早期膀胱灌注配合术后常规灌注。随访3 a肿瘤复发率,A组33.3%,B组8.3%,两者相比P〈0.05。复发肿瘤均不位于前列腺窝。认为与单行TURBt相比,TURBt＋P治疗浅表膀胱癌合并良性前列腺增生,能有效解除下尿路梗阻,减少肿瘤术后复发。     

经尿道前列腺等离子双极电切术与经尿道前列腺单极电切术的护理方法与效果探讨

目的 探讨经尿道前列腺等离子双极电切术(PKRP)与经尿道前列腺单极电切术(TURP)的护理方法,提高前列腺手术护理质量.方法 对两组患者均行术前心理指导和术后常规护理,对术后持续膀胱冲洗时间、下床活动时间、拔除尿管时间、住院时间以及术后主要并发症等方面作了统计学处理和对比分析.结果 PKRP组与TURP组比较护理质量有较大的优势.结论 PKRP组与TURP组比较,治疗效果完全相同,PKRP组术后留置导尿管时间、膀胱冲洗时间均较短,无经尿道前列腺电切综合并发症发生,有出血少,并发症更少,恢复快,住院时间短等优点,对提高护理工作效率和质量有重要意义,病人更乐于接受.     

索利那新对前列腺增生症患者TURP术后膀胱痉挛的防治作用观察

目的探讨琥珀酸索利那新防治良性前列腺增生症经尿道前列腺电切术（TuRP）术后膀胱痉挛的临床效果。方法将68例前列腺增生症行TURP术的患者随机分为两组。观察组（34例）于术后当日起口服索利那新5mg,1次／d。对照组（34例）术后出现膀胱痉挛疼痛剧烈时肌肉注射哌替啶50mg,比较两组术后72h内膀胱痉挛发生率、每例出现的次数及持续时间,拔尿管时间及不良反应发生率。结果术后72h内观察组现膀胱痉挛发生率及出现次数、持续时间均少于对照组,拔尿管时间短于对照组;药物相关性不良反应发生率低于对照组,P均〈0．05。结论索利那新对预防和缓解TURP术后膀胱痉挛效果显著;且不良反应发生率低。     

前列腺切除术后患者自控硬膜外镇痛防治膀胱痉挛

为观察患者自控硬膜外镇痛技术（PCEA）在前列腺切除术后膀胱痉挛防治中的效果，将60例行耻骨上经膀胱前列腺切除术患者术后按不同的解痉镇痛方法随机分为两组。观察组30例给予吗啡4mg、布比卡因150mg，生理盐水稀释成150ml，通过保留的硬膜外导管采用美国Baxter公司PCA－Ⅱ型自控镇痛泵持续给药，2ml/h。对照组30例给予杜冷丁50mg、阿托品0.5mg肌肉注射。所有患者均治疗3天，以疼痛视觉模拟评分法（VAS）间接评估镇痛效果，纪录膀胱痉挛次数、持续时间。结果术后膀胱痉挛发生率观察组为18％、对照组为83％（P＜0．01）；术后72小时内膀胱痉挛发生次数和持续时间观察组＜对照组（P＜0．01）；术后镇痛效果观察组好于对照组（P＜0．01）。认为PCEA能明显降低前列腺切除术后膀胱痉挛的频度和强度，镇痛效果优于其它方法。     

The incidence of perioperative myocardial infarction with transurethral resection of the prostate

We performed a prospective study of 250 men undergoing transurethral resection of the prostate to determine the incidence of perioperative myocardial infarction. The prevalence of coronary artery disease in the study group was 27%. Patients had measurement of total creatine kinase and its MB isoenzyme and electrocardiography preoperatively and on the first three postoperative days. Only one myocardial infarction was diagnosed, an incidence rate of 0.4%. The overall rate of serious post-operative complications was 3.6%. No deaths occurred during the operative hospitalization. We conclude that with transurethral resection perioperative myocardial infarction is a rare event despite the high prevalence of coronary artery disease in this surgical population. Routine postoperative surveillance with electrocardiograms and creatine kinase determinations in asymptomatic patients is not warranted.     

Persistent detrusor overactivity after transurethral resection of the prostate

Detrusor overactivity is associated with aging and benign prostatic obstruction and often causes the troublesome symptoms of urgency and urgency incontinence (overactive bladder), persistent detrusor overactivity after transurethral resection of the prostate being the cause of more than a third of poor symptomatic outcomes following surgery. Most of the evidence currently suggests that neurons of the urothelium at the bladder neck play a significant role in the genesis of detrusor overactivity. Treatment options including botulinum toxin injections and intravesical vanilloids have been studied in the treatment of persistent detrusor overactivity, but further studies are needed specifically in patients with persistent detrusor overactivity after transurethral resection of the prostate. As urodynamic studies are able to predict a proportion of postoperative failures, more widespread use is advocated by many in the routine assessment of lower urinary tract symptoms thought to be due to benign prostatic obstruction.     

Influence of comorbidity on outcome after pulmonary resection in the elderly

The aim of this study was to determine the influence of comorbidity on outcome after pulmonary resection in patients over 75 years old. Three hundred and thirty-three patients with non-small-cell lung cancer operated on between 1998 and 2002 were divided into 3 age groups: < 60 years (group 1), 60-75 years (group 2), > 75 years (group 3). Overall operative mortality was 0.3%; 30-day mortality was 1%. There were more major complications with re-operation in groups 1 and 2, but minor complications occurred significantly more frequently in group 3 (36% vs 16%). Overall mean hospital stay was 12 days, with no significant difference among groups. Three-year survival rates were: 80%, 70%, and 65% in groups 1, 2, and 3, respectively, with no significant difference among groups. Age or the presence of comorbidity should not be considered contraindications for lung resection. With proper patient selection and careful preoperative evaluation, many major complications after pneumonectomy are avoidable.     

以患者需求为导向的临床护理路径对心外科术后患者满意度及护理质量的影响性分析

摘要：目的：探讨与分析以患者需求为导向的临床护理路径对心外科术后患者满意度及护理质量的影响性。方法：2013年8月到2017年1月选择我院收治的心外科术后患者128例作为研究对象,按照入院顺序,根据随机信封抽签原则分为观察组与对照组各64例,对照组沿用目前常规临床护理模式,观察组给予以患者需求为导向的临床护理路径。结果：观察组与对照组术后14d的疼痛评分分别为1.33±0.67分和2.34±0.41分,都明显低于术后1d的7.29±2.19分和7.41±2.09分(P<0.05),可以看出在术后14d,就疼痛评分来说,观察组比对照组明显要低(P<0.05)。并且观察组在术后14d的遵医行为、合理用药、生活规律、病情监测的比例都比对照组高得多(P<0.05)。在满意度方面,观察组达到了100%,而对照组为89.1%,即观察组比对照组明显要高(P<0.05)。术后14d观察组的躯体化、抑郁、人际关系、强迫等评分都明显低于对照组(P<0.05)。结论：以患者需求为导向的临床护理路径在心外科术后患者的应用能提高护理质量,改善患者的满意度,更加有效缓解疼痛,促进患者自我良好行为的建立,从而提高生活质量。     

Effect of Blumgart anastomosis in reducing the incidence rate of pancreatic fistula after pancreatoduodenectomy

BACKGROUND Pancreatic fistula is one of the most serious complications after pancreatoduodenectomy for treating any lesions at the pancreatic head. For years, surgeons have tried various methods to reduce its incidence. AIM To investigate and emphasize the clinical outcomes of Blumgart anastomosis compared with traditional anastomosis in reducing postoperative pancreatic fistula. METHODS In this observational study, a retrospective analysis of 291 patients who underwent pancreatoduodenectomy, including Blumgart anastomosis (201 patients) and traditional embedded pancreaticojejunostomy (90 patients), was performed in our hospital. The preoperative and perioperative courses and longterm follow-up status were analyzed to compare the advantages and disadvantages of the two methods. Moreover, 291 patients were then separated by the severity of postoperative pancreatic fistula, and two methods of pancreaticojejunostomy were compared to detect the features of different anastomosis. Six experienced surgeons were involved and all of them were proficient in both surgical techniques.RESULTS The characteristics of the patients in the two groups showed no significant differences, nor the preoperative information and pathological diagnoses. The operative time was significantly shorter in the Blumgart group (343.5 ± 23.0 vs 450.0 ± 40.1 min, P = 0.028), as well as the duration of pancreaticojejunostomy drainage tube placement and postoperative hospital stay (12.7 ± 0.9 d vs 17.4 ± 1.8 d, P = 0.031;and 21.9 ± 1.3 d vs 28.9 ± 1.3 d, P = 0.020, respectively). The overall complications after surgery were much less in the Blumgart group than in the embedded group (11.9% vs 26.7%, P = 0.002). Patients who underwent Blumgart anastomosis would suffer less from severe pancreatic fistula (71.9% vs 50.0%, P = 0.006), and this pancreaticojejunostomy procedure did not have worse influences on long-term complications and life quality. Thus, Blumgart anastomosis is a feasible pancreaticojejunostomy procedure in pancreatoduodenectomy surgery. It is safe in causing less postoperative complications, especially pancreatic fistula, and thus shortens the hospitalization duration. CONCLUSION Surgical method should be a key factor in reducing pancreatic fistula, and Blumgart anastomosis needs further promotion.     

The frequency and significance of ECG changes after transurethral prostate resection

Although many clinicians routinely recommend a base-line preoperative electrocardiogram (ECG) and obtain frequent postoperative ECGs to screen for myocardial infarction or ischemia, the diagnostic utility of screening perioperative ECGs is unknown. The present analysis evaluates the sensitivity and specificity of the perioperative ECG and examines its value as a predictor of early postoperative cardiac events and outcomes during the postoperative year. ECGs obtained preoperatively and on the first 3 postoperative days in 206 men undergoing transurethral prostate resection were analyzed using the Minnesota Code. The occurrence of cardiac events during the operative stay was assessed by measurement of the cardiospecific MB creatine kinase isoenzyme on the first 3 postoperative days and review of the entire clinical course. Twenty-one percent of patients developed postoperative ECG changes, mostly involving the T wave; none had cardiac symptoms or sustained creatine kinase MB elevation. Changes were not significantly more common in men known to have coronary disease. The single patient who had a perioperative myocardial infarction confirmed by enzymes had no codable ECG changes. The specificity of any ECG change for perioperative infarction was 78%; of ST segment changes only, 95%. Only one of the patients (2%) who had postoperative ECG changes had a cardiac event in the year after surgery. Routine perioperative ECGs is of little diagnostic/predictive utility in situations in which the incidence of perioperative myocardial infarction is low.