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1.
三种经尿道前列腺切除手术的疗效比较   总被引:9,自引:0,他引:9  
目的:比较前列腺增生症(BPH)的三种经尿道手术的治疗效果。方法:分别采用尿道前列腺电切术(TURP)、经尿道前列腺电气化术(TUVP)和经尿道接触式激光前列腺切除术(TULP)治疗BPH共357例。结果:TULP及TUVP的手术时间比TURP缩短,出血明显减少,膀胱冲洗时间、置管时间及住院时间均短于TURP。结论:三种经尿道手术方法都是治疗BPH的有效手段,其疗效TURP与TUVP相似,TULP稍逊,但TULP跟TUVP与TURP比较操作更易掌握,出血量及并发症更少,联合应用TUVP和TURP或TULP相TURP可缩短手术时间、增加前列腺切除量和提高疗效。  相似文献   

2.
目的 比较经尿道前列腺汽化电切术与经尿道钬激光前列腺剜除术治疗前列腺增生症 的疗效。 方法 将160例前列腺增生症( benign prostatic hyperplasia,BPH)患者随机分为两组,每组80例,分别用 TUVP 及HoLEP 治疗 。比较两种术式 的手术时间、手术出血量、 膀胱冲洗时间 、住院时间、并发症及近期疗效等指标 。结果 两组患者术后国际前列腺症状评分 (IPSS)、生活质量评分( QOL)、最大尿流率和残余尿量均较术前明显改善,但两组上述指标间比较差异无显著性差异 。HoLEP组术中出血量、术后膀胱冲洗时间、住院时间明显短于TUVP组;并发症发 生率低于TUVP组。 结论 TUVP 及HoLEP 治疗前列腺增生症均有效;HoLEP的手术安全性优于TUVP。  相似文献   

3.
目的:探究经尿道前列腺电切术(TURP)、经尿道前列腺等离子切除术(PKRP)、经尿道前列腺等离子剜除术(PKEP)3种不同腔内技术对重度前列腺增生患者的疗效、手术相关指标、国际前列腺症状评分(IPSS)、生存质量评分(QOL)及术后并发症的影响。方法:选择2014年6月~2017年4月在我院接受治疗的185例重度前列腺增生患者为研究对象,按随机数字表法分为TURP组(n=60)、PKRP组(n=61)、PKEP组(n=64)。TURP组采用经尿道前列腺电切术,PKRP组采用经尿道前列腺等离子切除术,PKEP组采用经尿道前列腺等离子剜除术;观察三组手术持续时间、腺体切除量、术中出血量等手术情况,比较三组术前术后最大尿流率(Q_(max))、残余尿量(RUV)、IPSS评分及QOL评分,并统计三组术后并发症发生情况。结果:术后PKEP组临床总有效率高于TURP组和PKRP组(P0.05),而TURP组与PKRP组总有效率比较差异无统计学意义(P0.05);与TURP组比较,PKRP组和PKEP组手术持续时间、术中出血量、RUV水平及IPSS评分、QOL评分均降低,而腺体切除量及Q_(max)水平均升高,差异有统计学意义(P0.01);与PKRP组比较,PKEP组手术持续时间、术中出血量、RUV水平、IPSS评分及QOL评分均降低,而腺体切除量及RUV水平升高,差异有统计学意义(P0.01);三组术后并发症发生率比较差异有统计学意义(P0.05);三组术前Q_(max)、RUV水平、IPSS评分及QOL评分比较差异无统计学意义(P0.05)。结论:采用3种不同腔内技术治疗重度前列腺增生患者,PKEP组患者总有效率高、手术时间短、术中出血量少、腺体切除量多且并发症少,能有效缓解患者病症,提高生活质量,临床疗效显著。  相似文献   

4.
经尿道前列腺电切术后出血的原因及治疗研究   总被引:14,自引:0,他引:14  
目的:探讨经尿道前列腺电切术后出血的原因,为临床治疗提供帮助.方法:回顾分析2003年8月~2007年7月行经尿道前列腺电切术后出血的37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:出血原因包括术前、术中、术后三方面的因素.37例患者经加大冲洗速度、牵引力度及膀胱镜下再次止血等相应处理后止血理想.结论:经尿道前列腺电切术后出血的原因是多方面的,术前、术中、术后及时准确的处理是减少术后出血的关键.  相似文献   

5.
目的比较经尿道前列腺钬激光剜除术与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的效果。方法随机将58例BPH患者分为2组,各29例。对照组行TURP,观察组行经尿道前列腺钬激光剜除术。结果观察组手术时间、术中出血量及术后留置尿管时间、住院时间均少于或短于对照组,差异有统计学意义(P0.05)。2组术后3个月IPSS评分均较术前显著改善,差异有统计学意义(P0.05),但组间无显著性差异(P0.05)。结论经尿道前列腺钬激光剜除术与TURP均能有效改善BPH患者的临床症状,但前者术中出血量少,尿管留置时间短,更利于促进患者早期恢复。  相似文献   

6.
目的 比较并探讨钬激光前列腺剜除术(HoLEP)和传统经尿道前列腺电切术(TURP)的安全性及疗效,旨在为良性前列腺增生症的临床治疗提供理论依据.方法 回顾性分析哈尔滨医科大学附属第四医院2015年1月-2016年1月收治的349例良性前列腺增生症患者的病例资料,并将其随机分成两组.其中172例患者选择行钬激光前列腺剜除术,另外177例患者选择行传统经尿道前列腺电切术.比较两组患者术中出血量、手术时间、术后导尿管留置时间、术后住院天数以及术后并发症(尿失禁、膀胱痉挛、出血)的发病率.随访3个月,重新评估IPSS、QOL、Qmax指标并比较疗效.结果 与传统经尿道前列腺电切术组相比,钬激光前列腺剜除术组患者的手术时间明显缩短、术中出血量及术后住院天数显著降低(P<0.05),术后导尿管留置时间[钬激光前列腺剜除术组:(2.4±0.5)d;传统经尿道前列腺电切术组:(5.7±0.6)d,P<0.05].明显减少,术中切除前列腺重量明显增加,术后并发症的发病率[钬激光前列腺剜除术组:5/172(2.9%);传统经尿道前列腺电切术组:19/177(10.7%),P<0.01]显著下降.3个月后,两组术后PVR、IPSS、QOL以及Qmax较术前相比明显改善(P<0.01),组间比较差异无统计学意义(P>0.05).结论 钬激光前列腺剜除术与传统经尿道前列腺电切术相比疗效相当,但安全性更高.钬激光前列腺剜除术治疗临床前列腺增生症具有重要意义.  相似文献   

7.
目的探讨经尿道前列腺等离子电切术联合气压弹道碎石术治疗高龄高危前列腺增生并膀胱结石临床疗效。方法选择2011年1月至2012年12月我院收治的高龄高危前列腺增生(BPH)合并膀胱结石患者76例,随机分为2组:A组38例,采用经尿道前列腺等离子电切术联合气压弹道碎石术治疗;B组38例,采用经尿道前列腺等离子电切术联合耻骨上小切口切开取石术治疗。比较两组手术时间、术中出血量、膀胱冲洗时间、置管时间、术后住院时间、近期并发症,术前、术后3个月最大尿流率(MFR)、残余尿量、术前国际前列腺症状评分(IPSS)、生活质量(QOL)评分、梗阻评分。结果A组术中出血量、膀胱冲洗时间、置管时间、住院时间明显优于B组(P〈0.05),A组术后3个月MFR、残余尿量、IPSS评分、QOL评分、梗阻评分改善程度比B组明显(P〈0.05)。结论在充分做好术前、术中、术后处理和把握好禁忌证前提下,经尿道前列腺等离子电切术联合气压弹道碎石术可作为高龄高危BPH并膀胱结石患者首选手术方法。  相似文献   

8.
目的:探讨经尿道前列腺电切术中分别应用三种国产抗纤溶药——氨甲环酸、抑肽酶和止血芳酸对血小板的保护作用,以及对术后止血的功效.方法:选择60例良性前列腺增生手术患者,随机分为3组,即氨甲环酸组、抑肽酶组和止血芳酸组,测定术后12h,24h和48h的血小板计数、出血量、血浆纤溶酶活性和D-二聚体浓度。结果:术后血小板计数在氨甲环酸组和抑肽酶组相接近,在止血芳酸组则显着性下降。出血量在氨甲环酸组和抑肽酶组无显着性差异,在止血芳酸组显着性增高(P〈0.05)。血浆纤溶酶活性在氨甲环酸组和抑肽酶组显着性高于基础值,但仍有所降低;在止血芳酸组则显着性高于前二组。D-二聚体含量在三组间无显着性差异。结论.氨甲环酸和抑肽酶通过抑制纤溶亢进,均能确切减少前列腺电切术后的出血量,但抑肽酶存在潜在的过敏反应,且价格较贵,故以氨甲环酸更适宜於经尿道前腺电切术后止血。  相似文献   

9.
目的探讨经尿道单极前列腺剜除术与经尿道等离子前列腺剜除术的疗效及安全性比较。方法在2006年11月1日至2010年8月1日确诊为前列腺增生(BPH)的男性患者75例,符合纳入标准的患者随机分成两组,因前列腺包膜与腺体粘连紧密无法行剜除术3例,退出试验。经尿道单极前列腺剜除术组(TUERP)34例与经尿道等离子前列腺剜除术组(PKERP)38例,比较两组的手术时间、术中出血量、术后留置导尿管时间和术后住院时间,两组术后3个月与术前国际前列腺症状0PSS)、生活质量(QOL)评分及最大尿流率(Qmax)检查、残留尿量(RUV)、前列腺重量进行比较。结果两组间各项观察指标经独立样本t检验,差异无统计学意义(P〉0.05);各项观察指标手术前后比较,经配对t检验,差异有统计学意义(P〈0.05)。结论在保证手术技巧娴熟前提下,TUREP术与PKERP术相比,同样能够缩短手术时间、减少术中出血量、缩短术后留置导尿管时间和术后住院时间,其有效性和安全性相近,值得推广实行。  相似文献   

10.
目的探讨经尿道前列腺电切术后患者出血原因与防治方对策。方法回顾分析经尿道前列腺电切术后33例患者出血原因及治疗的临床资料。结果本组33例经药物保守治疗30例及膀胱镜下止血3例处理后出血停止。结论术前合并症控制不理想和术中止血不彻底,操作不规范及术后观察等均可导致术后出血的发生,术前应全面分析、规范术中操作及术后严密病情观察可减少TURP术后出血发生。  相似文献   

11.
经尿道前列腺电切术的失血观察及血凝酶应用的效果分析   总被引:2,自引:0,他引:2  
目的:观察经尿道前列腺电切术(TURP)患者术中和围手术期失血情况及其影响因素,观察注射用血凝酶(立芷雪)对TURP术后失血的作用和安全性.方法:BPH患者60例随机分为研究组1、组2(不同治疗方案)和对照组各20例,行TURP术,对比观察两组术前、术后第1天和第3天血红蛋白、出凝血并发症、是否输血、切除的前列腺体积、手术时间、术后膀胱持续冲洗时间、拔管时间、术后住院时间.研究组术后使用血凝酶,治疗破方案1:研究组在术后用2000 U静脉小壶滴入,每天1次,共3天;治疗方案2:研究组术后仅用一次2000 U静脉小壶滴入.对照组术后不用任何止血药.结果:全部患者手术成功,无并发症发生.主要观察指标:研究组1第1天血红蛋白97~132 g/L,平均118 g/L;第3天血红蛋白98~130 g/L,平均116 g/L.研究组2第1天血红蛋白100~130 g/L,平均117 g/L;术后第3天血红蛋白99~127 g/L,平均112 g/L.对照组术后第1天血红蛋白92~130 g/L,平均113 g/L,两组比较差异有统计学意义(P<O.05),术后第3天血红蛋白93~124 g/L,平均10.9 g/L,与组1比较P<0.01,与组2比较P<0.05.研究组2和对照组各有1例分别于手术当天和术后第2天输血.全部患者无心、脑血管意外和血液系统意外.次要观察指标三组比较差异无统计学意义.结论:TURP失血较多,尤其对前列腺较大和手术时间较长的患者.失血量主要与前列腺体积、手术时间、术者操作技术等因素相关.术后应用注射用血凝酶可以减少术后失血,不会增加凝血异常引起的心、脑血管疾患,特别是对并发心、脑血管疾病的患者更有益处.  相似文献   

12.
目的:研究局部应用蛇毒血凝酶减少全髋关节置换术失血量的有效性及安全性。方法:选择行单侧全髋关节置换术的患者45例,随机分为A、B、C组。A组不使用任何止血药物,B组在缝合关节囊后向关节腔内注射50 mL的氨甲环酸,C组在缝合关节囊后向关节腔内注射12 mL的蛇毒血凝酶注射液。统计、比较各组基本资料和血红蛋白、血小板、凝血常规及术中失血量、术后24 h引流量、输血率等指标,观察术后有无下肢深静脉血栓形成及肺部感染及切口感染等并发症。结果:3组术中失血量、术后深静脉血栓形成及肺部感染、切口感染等并发症发生率差异无统计学意义(P0.05)。术后24 h引流量3组分别为(396.7±139.5)mL、(303.3±91.5)mL、(206.7±106.7)mL,差异有统计学意义(P0.05),输血率3组分别为5/15、2/15、0,差异有统计学意义(P0.05);术后血红蛋白3组分别为(87.9±10.6)g/L,(96.9±10.7)g/L、(107.2±11.1)g/L,差异有统计学意义(P0.05);3组手术前后凝血常规、血小板变化差异无统计学意义(P0.05),均未出现血栓及肺部感染、切口感染等并发症。结论:局部应用蛇毒血凝酶注射液,能有效减少全髋关节置换术后失血量,降低输血率,并且不增加静脉血栓形成的风险。  相似文献   

13.
Total knee arthroplasty (TKA) often causes a significant amount of blood loss with an accompanying decline in hemoglobin and may increase the frequency of allogeneic blood transfusion rates. Unfortunately, allogeneic blood transfusions have associated risks including postoperative confusion, infection, cardiac arrhythmia, fluid overload, increased length of hospital stay, and increased mortality. Other than reducing the need for blood transfusions, reducing perioperative blood loss in TKA may also minimize intra‐articular hemorrhage, limb swelling, and postoperative pain, and increase the range of motion during the early postoperative period. These benefits improve rehabilitation success and increase patients’ postoperative satisfaction. Preoperative anemia, coupled with intraoperative and postoperative blood loss, is a major factor associated with higher rates of blood transfusion in TKA. Thus, treatment of preoperative anemia and prevention of perioperative blood loss are the primary strategies for perioperative blood management in TKA. This review, combined with current evidence, analyzes various methods of blood conservation, including preoperative, intraoperative, and postoperative methods, in terms of their effectiveness, safety, and cost. Because many factors can be controlled to reduce blood loss and transfusion rates in TKA, a highly efficient, safe, and cost‐effective blood management strategy can be constructed to eliminate the need for transfusions associated with TKA.  相似文献   

14.
目的观察围手术期全程血液管理对老年腰椎退行性疾病患者术中出血量、术后引流量以及输血量的影响,探讨减少围手术期出血的有效方法。方法回顾性分析2014年1月—2016年12月收治的90例老年退行性腰椎疾病患者,早期45例患者采用围手术期常规血液管理模式(常规组),后期45例患者采用围手术期全程血管理模式(全程组)。记录并比较2组患者手术时间、术中出血量、术后引流量、输血例数及输血量、血红蛋白浓度和红细胞压积。结果全程组手术时间、术中出血量、术后引流量、输血例数、输血量均低于常规组,术后3 d及1周血红蛋白浓度、红细胞压积均高于常规组,差异均具有统计学意义(P0.05)。结论老年腰椎退行性疾病患者采用围手术期全程血液管理可有效降低术中出血量和术后引流量,降低输血量和输血率,有利于患者术后恢复。  相似文献   

15.
目的探讨青年(≤40岁)肺癌患者术后快速恢复的影响因素。方法回顾性分析郑州大学第一附属医院胸外科2013年3月至2019年3月收治的82例经术后病理确诊的青年肺癌患者,按术后住院≤7天和>7天分为两组,收集病史及术前检查资料、术式和包埋材料、术后相关并发症及术后治疗等资料,分析各种因素与患者术后住院时间的关系。单因素分析采用t检验或Fisher确切概率法,多因素分析采用logistic回归模型,对数据进行分析。结果82例患者均成功完成手术,无围术期死亡。两组患者在术前肺功能、手术史、高血压病史、糖尿病病史、术前化疗史,术中患者体位、输血、胸膜粘连、捷力特、奈维、生物胶的使用、手术时间、肿瘤最大径,术后热灌注、发热、呕吐、呛咳、腹胀等方面差异均无统计学意义(P>0.05);而在术前抗生素使用(P=0.002)、改善肺功能(P=0.018)、吸烟史(P=0.024)、就诊原因(P=0.011),术中的术式(P<0.001)、切除范围(P<0.001)、淋巴结清扫(P=0.017)、止血粉使用(P=0.023)、失血量(P=0.001),术后白细胞计数(P=0.033)方面差异有统计学意义。结论术前、术后预防性使用抗生素及改善肺功能药物有利于患者术后恢复;吸烟是延长患者术后住院时间的独立危险因素;微创操作及运用止血材料可有效缩短患者术后住院时间。  相似文献   

16.
Purpose. The effects of preoperative aspirin (ASA) and/or heparin therapy on perioperative blood loss and transfusion requirements were studied in patients undergoing primary coronary artery bypass graft (CABG) surgery using perioperative blood cell salvaging techniques. Methods. The amounts of perioperative blood loss and transfusion requirements were recorded in four groups of patients, based on the preoperative medication: ASA group (51 patients), heparin group (33 patients), and ASA plus heparin group (38 patients), as well as a control group (49 patients who received neither of these medications). Results. There were no significant differences among the four groups in cardiopulmonary bypass time, aortic cross clamp time, or the number of coronary artery grafts performed. Postoperative blood loss was highest in the ASA group, followed by the control, the ASA + heparin, and the heparin groups. Neither postoperative blood loss nor transfusion requirements showed significant differences among the four groups. Simultaneous administration of heparin with ASA also did not increase the blood loss or transfusion requirements. Conclusion. Preoperatively administered aspirin and/or heparin did not significantly increase perioperative blood loss or the total amount of transfusion requirements. It is not necessary to delay elective CABG if blood cell salvaging techniques are used. Received for publication on July 9, 1997; accepted on September 20, 1998  相似文献   

17.
Wu Z  Zhou J  Pankaj P  Peng B 《Surgical endoscopy》2012,26(10):2758-2766

Background

Although laparoscopic splenectomy has been gradually regarded as an acceptable therapeutic approach for patients with massive splenomegaly, intraoperative blood loss remains an important complication. In an effort to evaluate the most effective and safe treatment of splenomegaly, we compared three methods of surgery for treating splenomegaly, including open splenectomy, laparoscopic splenectomy, and a combination of preoperative splenic artery embolization plus laparoscopic splenectomy.

Methods

From January 2006 to August 2011, 79 patients underwent splenectomy in our hospital. Of them, 20 patients underwent a combined treatment of preoperative splenic artery embolization and laparoscopic splenectomy (group 1), 30 patients had laparoscopic splenectomy alone (group 2), and 29 patients underwent open splenectomy (group 3). Patients’ demographics, perioperative data, clinical outcome, and hematological changes were analyzed.

Results

Preoperative splenic artery embolization plus laparoscopic splenectomy was successfully performed in all patients in group 1. One patient in group 2 required an intraoperative conversion to traditional open splenectomy because of severe blood loss. Compared with group 2, significantly shorter operating time, less intraoperative blood loss, and shorter postoperative hospital stay were noted in group 1. No marked significant differences in postoperative complications of either group were observed. Compared with group 3, group 1 had less intraoperative blood loss, shorter postoperative stay, and fewer complications. No significant differences were found in operating time. There was a marked increase in platelet count and white blood count in both groups during the follow-up period.

Conclusions

Preoperative splenic artery embolization with laparoscopic splenectomy reduced the operating time and decreased intraoperative blood loss when compared with laparoscopic splenectomy alone or open splenectomy. Splenic artery embolization is a useful intraoperative adjunctive procedure for patients with splenomegaly because of the benefit of perioperative outcomes.  相似文献   

18.
目的:探讨氨甲环酸减少一期全膝关节翻修术失血的有效性及安全性。方法将2014年8月至2015年9月在我院行一期全膝关节翻修手术的22例病人随机分为研究组(11例)和对照组(11例)。研究组在切皮之前将1.0 g氨甲环酸稀释于100 ml生理盐水后静脉滴注;对照组仅使用100 ml生理盐水静脉滴注。术后观察比较两组病人的血液和生化检查结果、出血及输血情况以及下肢深静脉血栓形成(DVT)的发生情况。结果两组病人术前的血红蛋白(HGB)、红细胞比容(HCT)比较,差异均无统计学意义(均P>0.05);研究组病人术后第3、5天的HGB和HCT均显著高于对照组,差异均有统计学意义(均P<0.05)。两组病人术中出血量的差异无统计学意义(P>0.05);研究组和对照组的术后输血量分别为(225.5±161.7)ml和(676.1±214.8)ml,总出血量分别为(1650.1±589.3)ml和(2469.2±684.6)ml,差异均有统计学意义(均P<0.05)。术后复查双下肢动静脉彩超,两组病人均未见DVT发生。结论一期全膝关节翻修术术前静脉滴注氨甲环酸能有效减少术中、术后出血量与输血量,有利于术后快速康复,且不明显增加术后血栓等并发症,建议在全膝关节翻修术中推广应用。  相似文献   

19.
The influence of two different methods of autologous transfusion, preoperative donor plasmapheresis (Abbott Autotrans) and postoperative autotransfusion (intraoperative blood salvage, Dideco Autotrans), on the intravascular hemostatic system was investigated. Forty-two patients undergoing total hip surgery and preoperative donor plasmapheresis were prospectively randomized into three groups. For substitution of blood loss, patients in group 1 (control group, n = 12) received in addition to cristalloids and colloids only homologous blood, group 2 (n = 14) autologous blood, and group 3 (n = 16) additionally intra- and postoperative autologous fresh frozen plasma (FFP). The investigation included blood parameters (hemoglobin, hematocrit, thrombocytes), clotting status (prothrombin time, plasma thromboplastin time, thrombin time, fibrinogen, plasminogen, and antithrombin III), and immunological methods such as fibrinopeptide A (FPA), thrombin-antithrombin III (TAT), and protein C. No significant difference was found with respect to total amount of infusion, intraoperative blood loss, autologous transfusion, and blood parameters. Excellent quality of the autologous FFP was demonstrated by investigation of the specimens before administration. The autologous packed red cells showed high levels of TAT and FPA as an indicator of thrombin generation. Their administration caused a significant increase in TAT and FPA levels in groups 2 and 3 compared to group 1.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

20.
BACKGROUND: The surgical correction of craniosynostosis may be associated with extensive blood loss and transfusion. The aim of this study was to compare the efficacy of the perioperative use of the continuous autotransfusion system (CATS group) and of the postoperative use of the CBCII ConstaVac(R) system (CV group) to reduce homologous transfusion in infants during repair of craniosynostosis. METHODS: Two groups of consecutive infants, weighing <10 kg, and scheduled for the surgical correction of craniosynostosis, were compared retrospectively according to the blood salvaging system used: CATS group and CV group. The primary endpoint was the comparison of the total volume of homologous blood transfused. RESULTS: There was no significant difference between the CV (n = 69) and the CATS (n = 135) groups with regard to physical, preoperative and postoperative data, except for the type of craniosysnostosis with more scaphocephaly in the CV group (P = 0.03). No significant difference in blood loss and homologous transfusion was observed between the two groups during the perioperative period. Two subgroups of patients were also compared: a subgroup including patients operated on with a linear craniectomy for scaphocephaly, and a subgroup including all other patients. There was also no significant difference in blood loss and homologous transfusion between the CV and the CATS groups for these two subgroups of patients. CONCLUSION: Our results suggest that the postoperative use of the CBCII ConstaVac(R) system is as efficient as the perioperative use of the CATS(R) system for reducing homologous blood transfusion during repair of craniosynostosis in infants weighing <10 kg.  相似文献   

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