开放性手术治疗良性前列腺增生症159例术后3年临床随访

目的评价开放性手术治疗老年人良性前列腺增生症（ＢＰＨ）的远期疗效。方法回顾性分析１９９１年１月至１９９３年１２月耻骨上经膀胱前列腺切除术治疗的老年ＢＰＨ患者１５９例，其中１３０例（８１．８％）得到随访，以填写问答表格的方法，统计患者对疗效的评价。结果术前症状总计分１７．４±８．０分，术后出院时为３．７±３．３分，总分下降幅度７１．３％；梗阻症状评分下降幅度（７７．９％）大于刺激症状评分下降幅度（４０．９％）。术前最大尿流率８．０±３．６ｍｌ／ｓ，平均尿流率２．９±１．９ｍｌ／ｓ；术后２０天左右分别为１６．７±８．１及１０．２±４．８ｍｌ／ｓ。患者对手术效果总满意率为８８．２％。结论开放性手术治疗老年人ＢＰＨ其效果肯定，术后严重并发症少，仍是一种治疗老年人ＢＰＨ的重要手段。     

萧山地区中老年田子良性前列腺增生的调查

目的 了解萧山地区中老年男性前列腺增大情况。方法 按国际前列腺增生症状评分（Ｉ－ＰＳＳ）。生活质量评分（Ｌ）。Ｂ超检查，尿流率，血ＰＳＡ，尿常规，直肠指检等７个方面调查。结果 受检９３８例，资料完整８４８例，发现前列腺增大５４．７％。其中５１～６０岁３７．２５％，６１～７０岁６２．７５％，７１～８０岁８１．３５％，８１岁以上７５％。结论 ＢＰＨ已成为中老年男性的多发病，应加强卫生宣传，提高人们对本     

前列腺增生症常用指标的应用分析

目的　探讨前列腺增生症（ＢＰＨ） 常用检查指标的临床价值及相互关系。　方法　对１００ 例临床ＢＰＨ病例的病程、症状评分、生活质量评估、前列腺体积、尿流率和膀胱残余尿进行了系统的检测和统计学分析。　结果　以上各项指标间仅存在较弱的相关性，其中症状评分和最大尿流率呈负相关（ ｒ ＝ － ０－２３ ，Ｐ＜ ０－０５） ，其和残余尿量呈正相关（ ｒ ＝ ０－２２ ，Ｐ＜ ０－０５） 。另外，分组对比结果提示：最大尿流率＜ １０ ｍｌ·ｓ －１ 和残余尿量≥５０ ｍｌ 是判断ＢＰＨ 病情的可靠参数，而不同症状评分组的尿流率、残余尿等指标则均无显著性差异。　结论　常用临床指标仅各自反映了ＢＰＨ 病理生理变化的一个方面，正确理解和综合分析各项指标的意义及其关系是准确把握临床ＢＰＨ 病情的基础     

自制止血导管在前列腺切除术中的应用观察

目的观察自制复合高压水囊前列腺止血导管在前列腺增生症（BPH）患者前列腺切除术中的应用效果。方法将372例行前列腺切除术患者随机分为两组,A组（268例）术中采用自制复合高压水囊前列腺止血导管止血,B组（104例）术中采用三腔Foley尿管止血。比较两组手术时间、术中出血量及术后尿道压和最大尿流率。结果A组手术时间及术中出血量明显少于B组（P均〈0．05）;术后两组患者尿道压、最大尿流率差别均无统计学意义（P均〉0．05）。结论BPH患者前列腺切除术中采用自制前列腺止血导管能有效缩短手术时间,减少前列腺窝出血,不影响手术效果。     

70岁以上老年人前列腺增生汽化术后性功能的临床观察

我院自 1996年 12月至 2 0 0 0年 10月 ,对 70岁以上良性前列腺增生 (ＢＰＨ)患者行经尿道前列腺汽化术 (ＴＵＲＶＰ)共35 8例 ,其中 139例进行了完整的随访 ,现就手术前后性功能的改变作相关的探讨 ,报道如下。　　一、临床资料　　 1.对象 :139例ＢＰＨ患者 ,年龄 70～ 92岁 ,平均 77岁 ,均有典型的前列腺增生症状。尿潴留 12例 ,残余尿 83～30 0ｍｌ,尿流率 :最大尿流率 0～ 12 1ｍｌ/ｓ,平均 5 5ｍｌ/ｓ ,平均尿流率 0～ 4 8ｍｌ/ｓ,平均 1 6ｍｌ/ｓ,。抗前列腺抗体(ＰＳＡ) 1～ 5 6ｎｇ/Ｌ ,均高于正常参考值 (0 8ｎｇ/Ｌ) ,国际前…     

老年前列腺增生症患者逼尿肌功能变化的尿动力学检测意义

目的探讨前列腺增生症（ＢＰＨ）患者逼尿肌功能变化的尿动力学特点及其临床意义。方法应用尿动力学技术，检查３５例ＢＰＨ患者的尿流率、膀胱充盈期和排尿期压力、膀胱感觉，观察膀胱容量－压力相关关系，测定剩余尿量，评估膀胱的稳定性、顺应性及逼尿肌受损程度。结果逼尿肌不稳定２２例（６２．９％），逼尿肌收缩功能受损８例（２２．９％），膀胱顺应性改变５例（１４．２％），表明ＢＰＨ可引起逼尿肌功能变化。结论尿动力学对判断逼尿肌功能状态、确定排尿功能障碍原因、选择药物治疗或手术适应证有重要意义。     

经尿道绿激光汽化术治疗21例高危患者前列腺增生症

良性前列腺增生（BPH）是老年男性的常见病，有进行性发展趋势，其中部分患者因出现尿潴留、膀胱结石、反复尿路感染、出血等并发症需要手术治疗。而≥80岁的老年人通常合并一种或多种慢性病，传统开放手术或经尿道电切术（TURP）风险较高。我科于2005年初引进美国Laserscope公司生产的Green—Light^TM PV激光系统（绿激光系统），对21例BPH患者实施了经尿道前列腺绿激光汽化术（PVP），该术式创伤小，近期效果满意，报道如下。     

改良耻骨上前列腺切除术的临床应用

采用自行设计的耻骨上前列腺切除术（下称改良术）对212例前列腺增生症（BPH）患者行前列腺切除。术中前列腺切除后只间断缝合颈口12点1－2针，然后立即采用尿管水囊牵引压迫止血，将出血封闭在前列腺窝内，形成一个有利于止血的封闭空间，无需时间特殊止血。手术时间平均18分钟，术中出血平均85ml，均未输血，均不置膀胱造瘘管。术后膀胱部首时间平均19.5小时，冲洗液用量为1500－3000ml；拔除尿管后均排尿通畅；尿流率、残余尿、生活质量和前列腺特异性抗原（PSA）较术前均有明显改善。认为改良术是一种快捷、简便、高效、值得推广的前列腺切除方法。     

经尿道汽化加电切术治疗65例老年前列腺增生患者分析

1998年 4月至 2 0 0 1年 11月我们采用经尿道前列腺汽化 (ＴＶＰ)结合电切 (ＴＵＲＰ)治疗老年人前列腺增生 (ＢＰＨ)6 5例 ,报道如下。　　一、对象和方法1.对象 :本组 6 5例 ,年龄 6 2～ 90岁 ,平均 74 5岁 ,其中 >80岁者 30例。 6 5例中合并肾功能不全 8例 ,并存慢性阻塞性肺疾病 9例 ,糖尿病 6例 ,高血压 13例 ,冠心病、心律失常 6例 ,脑中风后遗症 4例 ,肝炎及肝硬化 2例。ＢＰＨⅠ度 10例、Ⅱ度 36例、Ⅲ度 19例 ;均有典型的ＢＰＨ症状。平均术前最大尿流率 8 1ｍｌ/ｓ,剩余尿 86ｍｌ,国际前列腺症状评分 (ＩＰＳＳ) 2 4分。术前均做…     

高特灵治疗前列腺增生症43例临床报告

高特灵治疗前列腺增生症４３例临床报告江苏省老年医院外科（２１００２４）丁毅，樊盛军我科１９９４年４月起应用α１受体阻滞剂高特灵治疗前列腺增生症（ＢＰＨ）４３例，现将治疗情况报道如下。１临床资料１．１一般资料根据临床症状、直肠指检、尿流率、前列腺Ｂ超检...     

Surgery of coronary revascularization in patients over 70. Apropos of 40 cases

40 of the 900 patients operated upon for aorto-coronary bypass grafting between January 1980 and October 1984, were over 70 years old (mean 71.1; range: 70-76 years old). 25 had severe angina pectoris (class III or IV) and 15 of them had emergency surgery. An average of 2 grafts per patient was performed with 3 deaths and 3 myocardial infarcts in the peri-operative period. Patients had an average of 21 months follow-up (range 5 years, 3 months); in that period 2 deaths due to myocardial infarction, 3 persistent angina pectoris (class II) and 32 asymptomatic patients were observed. These results illustrate advances in cardiac surgery, anesthesia and postoperative management. Coronary surgery may therefore be performed in patients over 70 years old with an acceptable operative risk and satisfactory longterm results.     

Changes in blood pressure and heart rate variability during dental surgery

The objective of the present study was to determine the changes in blood pressure, pulse rate, and heart rate variability during dental surgery. The study included 40 patients, 19 to 74 years of age (mean age: 42.7 ± 3.0 years), who underwent tooth extraction at our hospital. Holter electrocardiographic monitoring was used to determine the power spectrum of R-R variability before and during dental surgery. The low frequency (LF: 0.041 to 0.140 Hz), high frequency (HF: 0.140 to 0.500 Hz), and total spectral powers (TF; 0.000 to 4.000 Hz) were calculated, and the ratio of LF to HF and percentage of HF relative to TF (%HF: HF/TF × 100) were used as indices of sympathetic and parasympathetic activities, respectively. The baseline blood pressure and pulse rate were 121 ± 3/70 ± 2 mm Hg and 70 ± 1 beats/min, respectively. After the administration of local anesthetic (2% lidocaine) containing 1:80,000 epinephrine, both the blood pressure and pulse rate increased. During dental surgery, blood pressure increased further to 132 ± 3/73 ± 2 mm Hg. The increase in blood pressure was greater in middle-aged and older patients (≥40 years old). In young patients (<40 years old), the %HF decreased and the LF/HF increased during local anesthesia. In contrast, in middle-aged and older patients, the LF/HF decreased during local anesthesia. These results suggest 1) that middle-aged and older patients have a greater increase in blood pressure during dental surgery than younger patients, and 2) that the regulation of the autonomic nervous system during dental surgery differs between younger and older patients.     

Economic Evaluation Study (Cheer Compliant) Laser Prostatectomy for Benign Prostatic Hyperplasia: Outcomes and Cost-effectiveness

To determine which surgical treatment for lower urinary tract symptoms, which is suggestive of benign prostatic hyperplasia (BPH), is more cost-effective and yields a better patient''s preference. Treatment outcome, cost, and perioperative complications to assess the treatment effectiveness of using laser prostatectomy as a treatment for BPH were investigated in this study.This retrospective study included 100 patients who underwent transurethral resection of prostate (TUR-P) and another 100 patients who received high-powered 120 W (GreenLight HPS) laser prostatectomy between 2005 and 2011.International Prostate Symptom Score and uroflow parameters were collected before the surgery and the uroflow and postvoiding residual volumes were evaluated before treatment and at 3, 6, 12, and 24 months after treatment. The results of 100 treatments after HPS laser prostatectomy were compared with the results of 100 patients who received TUR-P from the same surgeon. Complication rates and admission costs were analyzed.From 2005 to 2011, 200 consecutive patients underwent endoscopic surgery. Study participants were men with BPH with mean age of 71.3 years old. The peak flow rate went from 8.47 to 15.83 mL/s for 3 months after laser prostatectomy. Laser therapy groups showed better improvement in symptom score, shortened length of stay, and quality of life score when compared with those of TUR-P procedures. The estimated cost for laser prostatectomy was high when compared with cost of any other TUR-P procedural option at Chang Gung Hospital (P = 0.001). All admission charges were similar except for the cost of the laser equipment and accessories (mainly the laser fiber) (P = 0.001). Due to this cost of equipment, it increased the total admission charges for the laser group and therefore made the cost for the laser group higher than that of the TUR-P group.Perioperative complications, such as the need for checking for bleeding, urinary retention rate or urosepsis rate within 30 days after the surgery, held no significant differences between both groups.Compared with alternative treatment options, laser prostatectomy of the prostate is clinically effective but yields a high cost of treatment for symptomatic BPH.     

经蝶入路显微外科治疗老年人垂体腺瘤

目的探讨老年人垂体腺瘤（ＳＰＡ）的手术疗效。方法总结经ＣＴ扫描或ＭＲＩ确诊的５６例ＳＰＡ经蝶显微外科治疗的临床资料，３５例经唇下－鼻中隔－蝶窦入路、２１例经鼻前庭－鼻中隔－蝶窦入路行肿瘤切除术。结果本组微腺瘤７例，大腺瘤３０例，巨大腺瘤１９例，术后无死亡。４８例获长期随访（平均３．５年），４１例恢复良好；７例术后平均３．４年肿瘤复发，其中２例再次手术，５例采用药物、放疗或放射外科治疗，于３个月时复查见患者恢复较为满意。结论采取经蝶显微外科治疗ＳＰＡ，是一种安全、有较的方法     

Surgical procedures in selected proctological patients with local anesthesia. Study of 150 cases

Experience in the treatment of 150 patients with anorectal disorders and disorders of the sacrococcygeal region who were operated on with local anesthesia at the University Hospital, ABC Medical School, S?o Bernardo do Campo, SP, Brazil, from March 1995 to March 1998. The anesthesia technique, the operations carried out and the tolerance to the procedure are reported. Intraoperative morbidity was 10.6% (16 patients), and postoperative morbidity was 6% (nine patients). The age of patients was between 15 and 92 years old, with mean age 42 years old; 58% of patients were male and 42% female. Surgical mean time was 45 minutes and the patients remained in the hospital for a mean time of 8 hours. All of patients was instructed about the anesthesia technique, their advantages and disadvantages, and only with their permit the surgery was programmed. Hospitalization was required in five patients (3.3%). The anesthesia technique employed was the same for all patients. Upon survey, 96.7% of the patients stated they did not feel pain during the surgery and that they would go through the procedure again. The authors conclude the surgical treatment of anorectal disorders and disorders of the sacrococcygeal region with local anesthesia is viable and safe, and in addition, is well accepted by the patients.     

The effect of spinal anesthesia on pulmonary function tests in old patients

Pulmonary function test (PFT) results are mainly dependent on age, sex, height, weight, pulmonary mechanics disturbances and cooperation of the subjects. The position and anesthesia type may also influence the PFT results. In this study we aimed to evaluate spirometric changes in old and young patients who performed spinal anesthesia. Fifty patients performed spinal anesthesia were randomized in two groups: Group 1 (n= 25) aged 60-85 years old and group 2 (n= 25) aged 20-59 years old. After electrocardiography, noninvasive blood pressure and peripheral oxygen saturation (SpO2) monitorization, spinal anesthesia using 0.5% hyperbaric bupivacain from L 3-4 intervertebral space was applied. Sensory block levels, hemodynamics and PFT such as forced vital capacity (FVC), forced expiratory volume/1 second (FEV(1)), peak expiratory flow (PEF), and forced expiratory flow at the 25 and 75% of the pulmonary volume (FEF(25-75)) were performed before and after spinal anesthesia in 10th, 40th and 100th minutes in supine and 30 degrees head position using hand type spirometry. Wilcoxon paired two tests statistical analysis was used to compare PFT changes of the subjects. Mean arterial blood pressure levels and spirometric measurements of FVC, FEV(1) and FEF25-75 decrease with respect to basal values in 40th minutes was significant in old patients whom spinal anesthesia was over Th6 level but in young patients the changes were not significant. PFT decrement probabilities should be taken in account in old patients supposing for spinal anesthesia and be paid attention for high level spinal blocks in risk group patients.     

80岁以上患者股骨转子间骨折手术治疗(附85例分析)

目的探讨８０岁以上患者股骨转子间骨折的手术方式及疗效。方法回顾性分析８５例８０岁以上患者股骨转子间骨折的临床资料。其中采用滑动加压鹅头钉固定２６例，麦氏鹅头钉２５例，Ｅｎｄｅｒ钉８例，双加压螺丝钉９例，单加压螺丝钉１７例。结果术中无死亡病例，随访平均２８个月，功能恢复优良者５９例，占６９％；功能尚可者１４例；活动受限、疼痛、不能下床者１２例。结论手术治疗８０岁以上患者的股骨转子间骨折是延长患者寿命、改善其生活质量的有效方法。     

Effects of anesthetic agents and abdominal surgery on liver blood flow

The cause of postoperative liver dysfunction is often unclear, but a decrease in liver blood flow during anesthesia and/or major surgery may be important. Plasma half-life and clearance of indocyanine green were therefore measured in 42 patients before, during and after anesthesia and abdominal surgery. In 13 patients, liver blood flow was also estimated from indocyanine green extraction using hepatic vein catheterization. The major finding was an early decrease in estimated liver blood flow after induction of anesthesia, but not later during or after surgery. Mean indocyanine green half-life increased by 26% (p less than 0.005), mean indocyanine green plasma clearance decreased by 19% (p less than 0.01) and mean estimated hepatic blood flow decreased by 36% (p less than 0.005) during the first 30 min of anesthesia. These changes were greater in males and in patients older than 55 yr, but changes were similar with each of three anesthetic groups. Half-life, but not indocyanine green clearance, was also significantly prolonged by mid-operation in the older (greater than 55 yr) patients and in those undergoing lower abdominal surgery. We suggest that this period of reduced liver blood flow during anesthesia is caused by the effects of neuromuscular blocking agents and may contribute to postoperative liver damage.     

What Can Be Expected of Balloon Aortic Valvuloplasty in Adults?

Introduced more than 15 years ago, balloon aortic valvuloplasty (BAV) has clearly delineated indications and limitations. Although, aortic valve replacement is undoubtedly the treatment of choice for healthy patients with aortic stenosis, BAV has been demonstrated as a valuable and safe palliative procedure for patients considered too risky or old for current day surgery. Between January 1991 and December 1999, 858 patients (mean age 76 ± 11 years, 479 [57%] women) underwent BAV at our center. Indications for BAV were contraindication to surgery in 16.2% of the patients, high risk in 40.4%, refusal of surgery in 10.7%, personal decision in 18.5%, and other in 14.2%. The mean gradient decreased from 65 ± 23 to 27 ± 12 mmHg and the valve area increased from 0.56 ± 0.19 cm² to 1.0 ± 0.38 cm². Eleven (1.1%) patients died during the procedure. The other severe complications were complete AV block in 18 (1.8%) patients, stroke in 8 (0.8%), tamponade in 6 (0.6%), and massive aortic insufficiency in 4 (0.4%). In conclusion, BAV does not replace valve replacement, even in the elderly. All those who can be operated on, should be. However, if surgical intervention is not considered reasonable, BAV offers good immediate results with an acceptable complication rate. Furthermore, previous published series have demonstrated that BAV is particularly indicated in specific subgroups, such as very old patients with high operative risk, end-stage heart failure, cardiogenic shock, or general anesthesia for noncardiac surgery.     

高龄冠心病患者的经皮冠状动脉介入治疗

目的 :总结高龄冠心病介入治疗的经验。方法 :回顾分析我院 1997年 2月至 2 0 0 1年 12月连续 12 6例 70岁以上的冠心病病人的介入治疗资料 ,其中多支病变占 89 7%。 193处靶病变行PTCA、冠状动脉支架、切割球囊扩张和旋磨 ,其中复杂病变占 86 5 %。结果 :病例成功率 95 2 % ,病变成功率93 3%。其中 33例急性心肌梗死介入治疗梗塞相关血管开通率 10 0 %。慢性闭塞病变 2 1处 ,成功率81 0 %。 112例病人行冠状动脉支架术 (占 88 9% )。术前靶血管平均狭窄 (85 6± 11 3) % ,术后平均残余狭窄 (5 2± 6 1) %。严重并发症率 4 0 % ,其中死亡率 2 4 %。 1例 (0 8% )行紧急冠脉架桥术 ;1例(0 8% )Q波心梗。急性闭塞 5例 (4 0 % ) ,心包填塞 1例 (0 8% ) ;5例 (4 0 % )病人出现消化道出血 ,1例(0 8% )病人发生脑出血。结论 :70岁以上的高龄冠心病人的介入治疗成功率高、并发症的发生率也是可以接受的