腹腔镜下耻骨后腹膜外保留尿道的前列腺切除术

目的探讨腹腔镜下经耻骨后腹膜外保留尿道的前列腺切除术治疗大腺体前列腺增生症的可行性。方法自2006年1月至2007年1月对9例前列腺增生症的病人采用腹腔镜行耻骨后腹膜外前列腺切除术,病人年龄为(77.8±6.8)岁,范围为(62～83)岁。经直肠前列腺B超显示前列腺大小为(101.3±36.2)g,范围为(62～172)g,均无明显中叶增生。腹腔镜手术包括耻骨后腹膜外腔的建立、排列成倒U字形5个穿刺套管的放置、前列腺被膜的切开、增生腺瘤的切除、前列腺部尿道的保护及前列腺被膜的缝合等主要步骤。结果9例病人手术顺利,术中出血(190±160.6)ml,范围为(60～600)ml,手术时间为(174±59.8)min,范围为(90～240)min。术后恢复顺利,尿管拔除时间为(8.4±3.8)d。术后3月复查病人尿流率、国际前列腺症状评分(IPSS)评分、生活质量评分(QOL)等较术前明显好转。术前有性功能的4例病人术后性功能无损。结论对腺体大的前列腺增生症行腹腔镜下经耻骨后腹膜外行前列腺切除术是可行的,病人创伤小、恢复快、效果满意。     

腹腔镜耻骨后单纯前列腺切除术

作者报告腹腔镜耻骨后单纯前列腺切除术治疗体积较大的良性前列腺增生(BPH)的初步结果。17例患者接受治疗。平均年龄为69．7岁(53～82岁)。术前常规检测PSA、评估IPSS评分和生活质量(QOL)评分。经直肠超声检查提示前列腺体积均＞60g，平均为93g。手术采用5通道，膀胱前列腺连接部近端横切口，前列腺切除后，膀胱三角区下移缝合于前列腺窝内。     

耻骨上经膀胱保留后尿道前列腺切除术

报告３２例耻骨上经膀胱保留后尿道前列腺切除术治疗良性前列腺增生症。手术顺利，手术时间平均４２分，术中平均出血４０ｍｌ，切除腺体平均５２．４ｇ，术后无出血、感染、尿失禁等并发症，随访半个月－２３个月，排尿通畅，剩余尿０－３１ｍｌ，平均最大尿流率〉１８ｍｌ／ｓ     

腹腔镜下耻骨后保留尿道前列腺切除术与经尿道前列腺电切术的比较

目的:比较腹腔镜下耻骨后保留尿道前列腺切除术与经尿道前列腺电切术(transurethral resection of prostate,TURP)治疗大体积前列腺的手术效果。方法:将2013年12月至2014年12月入院的40例前列腺体积大于80 ml的患者按计算机随机数字法分为两组,20例接受腹腔镜下耻骨后保留尿道前列腺切除术,20例接受TURP,应用独立样本t检验方法对比两组患者年龄、术前前列腺体积、国际前列腺症状评分(international prostate symptom score,IPSS)、生活质量指数评分(quality of life score,QOL)、最大尿流率(maximum flow rate,Qmax)、残余尿、血红蛋白、手术时间、术中出血量、术后冲洗时间、留置尿管时间、术后住院时间、术后3个月IPSS、QOL、Qmax、残余尿的差异。结果:两组年龄、术前前列腺体积、IPSS、QOL、Qmax、残余尿、术前血红蛋白、术后3个月IPSS、QOL、Qmax差异无统计学意义(P0.05),手术时间、术中出血量、术后冲洗时间、拔除尿管时间、术后住院时间两组相比差异有统计学意义(P0.05)。结论:腹腔镜下耻骨后保留尿道前列腺切除术治疗大体积前列腺较TURP具有优势,表现为手术时间短、出血量少、术后冲洗时间短、留置尿管时间短等。     

耻骨上前列腺切除术后并发症的防治

目的：探讨耻骨上前列腺切除术后常见出血,尿失禁、前列腺窝品狭窄和膀胱无抑制痉挛４种并发症的原因及防止方法,方法：采用窝品周圈深“８”字环扎血管及术皇导尿管牵拉压迫或术中经尿道电切镜电灼术;术中避免损伤胱外括约肌;缝合窝口时不缩紧,保证可容２指大小;术后由骶管内持续注入０．１２５％布比卡因,结果：采用以上措施经治１０９例患者,取得较好的临床效果,与经典的耻骨上前列腺切除术相比,术后并发症的发生率明显     

改良式耻骨上经膀胱前列腺切除术的应用

良性前列腺增生症（BPH）是男性老年患者的常见疾病。耻骨上经膀胱前列腺切除术治疗BPH是较为常见的手术方式，但术中止血困难，术后尚需冲洗膀胱。自1992年6月～1997年6月，我们采用改良式耻骨上经膀胱前列腺切除术治疗BPH46例，术中、术后出血少，且不需膀胱冲洗，现报告如下。1资料与方法1．1；临床资料本组46例，年龄55～77岁。全部病例均有排尿困难史，并经直肠指检或膀胱镜检查发现前列腺增生，其中29例有尿潴留史，8例伴有膀胱结石。除9例在术前未用抗生素前行尿细菌培养外，全部病例均予术后2周、3个月行尿细菌培养。1．2手术方…     

腹腔镜下耻骨后保留尿道前列腺切除术 技术成熟前后与经尿道前列腺等离子 电切术的临床比较

目的 探讨技术成熟后腹腔镜下耻骨后保留尿道前列腺切除术的可行性及临床价值。方法收集本院2013年1月至2016年12月住院的大体积（＞80 mL）良性前列腺增生(benign prostatic hyperplasia,BPH)患者的临床资料,按照设定的入选及排除标准共有104例患者入组。研究分为三组,A组：2013年1月至2014年12月行腹腔镜下耻骨后保留尿道前列腺切除术的患者22例;B组：2013年1月至2016年12月行经尿道前列腺等离子电切术（transurethral plasmakinetic resection of the prostate, PKRP）的患者57例;C组：2015年1月至2016年12月行腹腔镜下耻骨后保留尿道前列腺切除术的患者25例。记录每组患者年龄、前列腺体积、国际前列腺症状评分（IPSS）、残余尿测定（RUV）、最大尿流率（Qmax）,术中手术时间、出血量;术后膀胱冲洗时间、留置尿管时间、住院时间;术后3个月IPSS评分、RUV、Qmax,最后对结果进行统计学分析。结果 ①早期腹腔镜下耻骨后保留尿道前列腺切除术手术时间长、术中出血多,技术成熟后可明显缩短手术时间,减少术中出血量;②该手术成熟后在不延长手术时间的前提下,术后3个月疗效与TPKRP相当;③该手术与TPKRP相比,可以缩短膀胱冲洗时间、拔管天数以及术后住院天数。结论 成熟的腹腔镜下耻骨后保留尿道前列腺切除术是治疗大体积（＞80 mL）BPH安全有效的方法。     

开放腺窝的耻骨上前列腺切除术

1 临床资料 1987-10/2001-06我们采用开放腺窝的耻骨上经膀胱前列腺切除术(TVP)治疗前列腺增生症患者252例,年龄53～86(平均70.8)岁。均有BPH临床症状,直肠指诊按Rous标准(1985),前列腺增生Ⅱ°71例,Ⅲ°144例,Ⅳ°37例。有尿潴留病史102例。合并膀胱憩室者9例,膀胱结石者13例,腹股沟斜疝者11例,内痔严重脱出者9例,高血压67例,冠心病24例,老年性肺气肿34例,脑中风后遗症5例。其中34例国际前列腺症状评分(IPSS)29.8±2.0,生活     

耻骨上经膀胱前列腺切除术手术配合技巧

作报道60例耻骨上经膀胱前列腺切除术的手术配合技巧。60例患手术顺利，无1例出现意外情况及因术中并发症而再次手术。介绍及讨论了器械应用、重要手术步骤配合技术及原理，并对一些术中并发症的预防进行了讨论。     

耻骨上经膀胱前列腺切除术应注意的若干问题

前列腺增生症(BPH)治疗的目的是改善症状,减轻梗阻,增加膀胱排空,预防泌尿道感染和肾功能衰竭。BPH治疗的总趋势是药物治疗和微损伤疗法日益发展,手术治疗随之减少。国际上推荐的前列腺治疗技术的4项标准是:1临床疗效好;2并发症少;3技术简单,容易掌握;4价格较低。实践证明...     

Persistent bacteriuria following simple suprapubic prostatectomy

Among 65 patients who underwent simple suprapubic prostatectomy, three consecutive quantitative estimations of clean voided midstream urine were carried out, i.e. before operation, on discharge from hostpital and six months or later after operations (late review), respectively, and some factors that will affect persistent significant bacteriuria were discussed. The results thus obtained were as follows.

1. Incidence of persistent significant bacteriuria at late review was 30.8% in patients with significant bacteriuria preoperatively and this figure was higher than 17.7% in patients without significant bacteriuria preoperatively.
2. Duration of postoperative indwelling urethral catheterization plays a less significant role than the presence of preoperative bacteriuria in the persistent significant bacteriuria on discharge and at late review.
3. Size of the enucleated prostate also showed no significant relationship to the persistent significant bacteriuria at late review.

     

耻骨上经膀胱前列腺摘除术后尿失禁

１９８８年８月～１９９２年８月行耻骨上经膀胱前列腺摘除术２２０例，其中２０例（９．１％）术后早期出现尿失禁症状，１４例随访半年后症状消失，６例（２．７％）仍有持续性尿失禁。前列腺术后尿失禁的发生与术前合并尿路感染、膀胱结石、合并有神经系统疾病以及前列腺过大或过小有关。通过２０例患者的尿流动力学检查，认为尿流动力学对前列腺术后尿失禁的诊断、分型、预测预后和治疗方案的制定有很大帮助。     

Symmetrical peripheral gangrene after suprapubic prostatectomy

Symmetrical peripheral gangrene is a rare condition with a multifactorial etiology and its treatment has not been clarified. The second case to have occurred in urologic patients is reported herein. This case highlights the need to be aware of this potential complication of urologic surgery.     

Synchronous suprapubic prostatectomy and inguinal herniorrhaphy

Synchronous suprapubic prostatectomy and inguinal herniorrhaphy were performed on 12 patients who presented with benign prostatic hypertrophy and concurrent inguinal hernia(s). The results of these were compared with those of 12 other (control) patients, matched for age, who presented with benign prostatic hypertrophy only and who had suprapubic prostatectomy by the same surgical team under similar operative conditions. The results showed that while the additional herniorrhaphy increased the operating time by 30 min and increased the mean blood loss by 250 ml, it did not carry any other significant morbidity. This approach eliminates multiple hospitalisation and operations, multiple anaesthesia and prolonged catheterisation, and lowers the high cost of hospitalisation.     

A retrospective evaluation of suprapubic prostatectomy

Suprapublic prostatectomies performed on 89 patients from January 1977 to December 1981 were retrospectively evaluated as regard to operative risk, preoperative and postoperative complications. The patients were from 56 to 87 years old with a peak distribution in the seventies. Common preoperative complications were urinary tract infection, coronary sclerosis followed by hypertension. The operation time for resection and weight of resected adenoma averaged 46.5 minutes and 35.1 g, respectively. Average blood loss during operation was 179 ml. The most frequent postoperative complication was acute epididymitis. There were no operative deaths. Prostatic incidental carcinoma was found in 3 cases of resected adenomas by histological examination. There were statistically significant correlations between adenoma weight and duration of postoperative urinary tract infection (r = 0.38, p less than 0.01) and between operation time and blood loss (r = 0.42, p less than 0.01). In contrast, preoperative urinary tract infection had no influenced on duration of postoperative urinary tract infection or postoperative gross hematuria.