TUVP联合TURP治疗高龄高危前列腺增生疗效观察

目的 评价经尿道前列腺电汽化术联合电切术治疗高龄高危前列腺增生症的临床效果.方法 对46例高龄高危前列腺增生患者在积极进行个体化围手术期处理的基础上用经尿道前列腺电汽化术(TUVP)加电切术(TURP)进行治疗,疗效经国际前列腺症状评分及生活质量评分进行评价.结果 46例患者安全实施手术,手术平均时间56min,电切前...     

经尿道电汽化联合电切治疗高龄高危前列腺增生的临床研究

目的:探讨高龄高危前列腺增生经尿道前列腺电汽化联合经尿道电切的安全性及围手术期的处理。方法:联合应用经尿道前列腺电汽化和经尿道电切治疗高龄高危前列腺增生患者50例。结果:50例手术均顺利完成,术后随访3~12个月,国际前列腺症状评分由术前(28.7±5.4)分降至(9.6±3.4)分,生活质量评分由术前(5.4±0.7)分降至(2.6±0.3)分,最大尿流率由术前0~9 m L/s升至(15.6±3.7)m L/s,残余尿量由术前85~600 m L降至16~40 m L(P<0.01)。结论:经尿道前列腺电汽化和经尿道电切治疗高龄高危前列腺增生,具有症状改善明显,疗效确切,较为安全,无明显并发症发生的特点。     

经尿道前列腺汽化电切术结合经尿道前列腺电切术治疗前列腺增生症

目的：探讨经尿道前列腺汽化电切术(TUVP)结合经尿道前列腺电切术(TURP)治疗前列腺增生患者的价值。方法：结合三种电极的特点回顾性分析146例前列腺增生患者接受TUVP和TURP治疗后的疗效。结果：全部患者均安全度过围手术期，术后疗效满意，无严重并发症，提高了高龄高危患者的生活质量。结论：TUVP结合TURP是治疗前列腺增生的安全有效的方法。     

高龄高危良性前列腺增生患者合并腹股沟疝的同期手术治疗体会

目的 探讨高龄高危良性前列腺增生(BPH)合并腹股沟疝的同期手术方法及其治疗效果并总结经验.方法 回顾性分析2006年8月至2011年10月收治的46例高龄高危良性前列腺增生合并腹股沟疝患者的临床资料,采用前列腺选择性绿激光汽化术(PVP)联合经尿道前列腺电切术(TURP)处理增生的前列腺组织,选用聚丙烯单丝补片(美国巴德公司)进行腹股沟疝无张力修补术.结果 本组46例随访5～48个月,无一例疝复发,无切口感染、尿失禁、经尿道电切综合征及尿道狭窄.3例出现腹股沟区不适感,2例切口脂肪液化,6例轻度尿路刺激征,4例短暂排尿困难,上述并发症对症处理后治愈.结论 PVP联合TURP加无张力疝修补术处理高龄高危良性前列腺增生患者合并腹股沟疝,一期手术完成,创伤小,出血少,手术时间短,避免了二次麻醉风险和手术打击.     

经尿道前列腺汽化电切术治疗高龄高危前列腺增生症68例报告

目的总结经尿道前列腺汽化电切除术对高龄高危良性前列腺增生症（BPH）的疗效和安全性。方法应用铲状电极经尿道汽化术联合电切术治疗75岁以上高危高龄BPH患者68例。结果手术时间40~120 min、平均（69.8±19.3）min,术中出血少,均未输血,无前列腺电切综合征（TURS）及真性尿失禁发生,国际前列腺症状评分（IPSS）平均值由术前26.7降至8.4分,平均最大尿流率（Qmax）由8.2 mL/s增至15.3 mL/s,差异均有非常显著性意义（P均〈0.01）。随访3~18个月,平均（12.5±4.2）个月。全部患者术后均排尿通畅。所有患者术后均未有心、脑、肝、肾等系统疾病加重。结论应用铲状电极经尿道汽化切割增生组织速度较快,联合电切环修切,安全性高、并发症少、疗效确切,是治疗75岁以上高龄高危BPH患者安全有效的方法,明显拓宽了BPH的手术适应证。     

TURP联合TURVP治疗高龄高危患者良性前列腺增生

目的探讨经尿道前列腺汽化术（Transurethral electrovaporization of the prostate,TUVP）联合经尿道前列腺电切术（Transurethral resection of the prostate,TURP）治疗高龄高危良性前列腺增生（Benign prostatic hyperplasia,BPH）的安全性及临床疗效。方法对我院在2001年～2009年12月TUVP联合TURP治疗53例高危BPH患者进行回顾性分析。结果 53例均顺利完成手术,无手术死亡及大出血、电切综合征发生。拔除尿管后排尿通畅,国际前列腺症状评分（IPSS）和生活质量评分（QOL）改善,最大尿流率明显增加。结论 TUVP联合TURP治疗高龄高危良性前列腺增生创伤小、恢复快,疗效显著。     

经尿道等离子体双极汽化电切术治疗高龄高危前列腺增生症患者的临床探讨(附248例报告)

目的 探讨经尿道等离子体双极汽化电切术(PKRP)治疗高龄高危前列腺增生症(BPH)患者的安全性及策略.方法 自2003年9月至2011年12月共248例高龄高危良性前列腺增生症患者行经尿道等离子体双极汽化电切术(PKRP),术前进行风险评估及充分准备,改进手术操作技巧,提高围手术期安全.结果 手术时间30～ 100min,平均70min;切除前列腺组织重45 ～ 110g,平均55g.术中出血少,无输血.248例患者均安全渡过围手术期,无电切综合征(TURS)和真性尿失禁等严重并发症.早期暂时性尿失禁18例,经口服“酒石酸托特罗定片”和提肛训练1～3周恢复.所有患者随访6个月以上,排尿症状消失或明显改善.结论 经尿道等离子体双极汽化电切术(PKRP)仍是治疗高龄高危前列腺增生症患者安全、有效的方法.     

经尿道前列腺汽化电切术治疗前列腺增生的体会(附648例报告)

目的探讨经尿道前列腺汽化结合电切术治疗前列腺增生的疗效。方法回顾总结经尿道前列腺汽化结合电切术治疗前列腺增生患者648例。结果手术过程顺利、出血少、疗效满意，未出现严重并发症。结论经尿道前列腺汽化电切术治疗前列腺增生疗效确切，并发症少，容易掌握。     

TUVP与TUPKVP结合治疗高危重度BPH45例

我院从2005年12月-2007年2月采用经尿道前列腺电切汽化术（TUVP）结合经尿道前列腺等离子体双极电切汽化术（TUPKVP）治疗高危重度前列腺增生（BPH）患者45例，取得满意的效果，现报告如下。     

高危前列腺增生合并膀胱结石的手术方法探讨

目的探讨高危前列腺增生合并膀胱结石安全有效的治疗方法。方法回顾性分析2000年1月至2010年6月就诊我科的高危前列腺增生合并中等大小膀胱结石（4～10cm2）82例患者的临床资料：对照组42例采用经尿道气压弹道碎石术联合经尿道前列腺汽化电切术（TUVP-TURP）,研究组40例采用经皮膀胱镜弹道碎石联合经尿道前列腺汽化电切术,对两组患者的手术时间、术中出血量、并发症和术后随访情况等进行分析比较。结果研究组手术时间和出血量明显少于对照组（P〈0．05）,两组并发症、术后随访IPSS评分和最大尿流率无明显差别（P〉0．05）。研究组电切综合征的发生率明显低于对照组（P〈0．05）,而两组患者前列腺包膜穿孔、尿失禁、输尿管口损伤、出血和周围脏器损伤等并发症的发生率无明显差异（P〉0．05）。结论TUVP—TURP联合经皮气压弹道碎石是治疗高危前列腺增生合并中等大小膀胱结石的一种安全有效的方法。     

高渗氯化钠-羟乙基淀粉用于前列腺电切术的可行性

目的:研究前列腺肥大的患者在腰硬联合麻醉下行前列腺电切术时输注高渗氯化钠-羟乙基淀粉(hypertonic sodium chloride hetastarch,HSH)预防经尿道电切综合征的作用.方法:随机将60例前列腺肥大患者分为A组(观察组)和B组(对照组)各30例.观察组术前先输注复方氯化钠,手术开始后输注HS...     

妇科腹腔镜手术腰麻联合硬膜外麻醉的效果

目的:评价妇科腹腔镜手术腰麻联合硬膜外麻醉(combined spinal-epidural anesthesia,CSEA)的效果。方法:择期选择妇科腹腔镜手术患者1000例,ASAⅠ～Ⅱ,随机分为CSEA组和连续硬膜外麻醉组(epidural anesthesia,EA),每组500例,记录入室后(基础值)和注入首剂量局麻药后1min、5min、10min、15min时的SP、DP、MAP、HR、SpO2、PETCO2。观察麻醉前(T1)、气腹即刻(T2)、气腹后20min(T3)、气腹后30min(T4)、气腹后40min(T5)、气腹后50min(T6)两组各指标的变化。记录开始注入局麻药至出现满意阻滞平面的时间、肌松程度、局麻药总量、丙泊酚总量。结果:阻滞平面达T6时间两组有极显著差异(P<0.01)。局麻药总量,丙泊酚总量EA组明显增多(P<0.05),两组SP、DP、MAP、HR、SpO2、PETCO2比较差异无统计学意义(P>0.05)。镇痛效果及肌松程度CSEA组优于EA组。结论:与硬膜外阻滞相比,妇科腹腔镜手术患者腰麻联合硬膜外麻醉有较好的镇痛、肌松效果,且局麻药用量、丙泊酚用量较少。     

A prospective study of transperineal prostatic block for transurethral needle ablation for benign prostatic hyperplasia: the Emory University Experience.

PURPOSE: We evaluate the feasibility, effectiveness and role of transperineal prostate block in providing anesthesia during minimally invasive radio frequency thermal therapy of the prostate. MATERIALS AND METHODS: A total of 38 consecutive patients undergoing transurethral needle ablation for symptomatic benign prostatic hyperplasia were entered in this prospective study. All patients received transperineal prostatic block as the main method of anesthesia. A mixture of equal volumes of 1% lidocaine and 0.25% bupivacaine, each with epinephrine (1:100,000 concentration ratio) was used. Pain control during the instillation of transperineal prostatic block and transurethral needle ablation was assessed using a 10-point linear analog pain scale and questionnaire. RESULTS: Median patient age was 65.5 years (range 47 to 79), with 21% of men in the eighth decade of life. Median American Urological Association symptom score was 25.0 (range 14 to 35), bother score was 20.0 (11 to 28), quality of life score was 4.0 (3 to 6) and peak urinary flow rate was 8.9 cc per second (3.5 to 15.7). Median sonographic prostate volume was 35.0 cc (range 17 to 129). Median volume of anesthetic agent used was 40.0 cc (range 30 to 60) per case (1.1 cc solution per 1 cc prostate tissue). No adverse events were encountered. Median pain score was 3.3 (range 1 to 6) during instillation of transperineal prostatic block and 1.0 (0 to 6) during transurethral needle ablation. Transperineal prostatic block proved highly effective and was a satisfactory method of anesthesia during transurethral needle ablation as judged by postoperative questionnaire. No sedation, narcotic or analgesia was required. All procedures were performed in the outpatient cystoscopy suite or office setting without support of an anesthesia team or conscious sedation monitoring. CONCLUSIONS: Transperineal prostatic block is a safe, convenient, effective and satisfactory method of minimally invasive anesthesia for transurethral needle ablation of the prostate in an outpatient office setting. Elderly patients and those at high surgical risk can be treated safely using this approach. Considerable cost saving is seen secondary to omission of charges related to anesthesia team support, recovery room facility and conscious sedation monitoring.     

State of hemostasis system at transurethral prostatic resection

Hemostasis system was examined at 58 patients who underwent transurethral prostate resection due to benign prostatic hyperplasia. All the patients were divided into 2 groups: the study group where the surgery was performed under spinal anesthesia, and control - under intravenous anesthesia. The hemostasis system was examined before surgery and on 1st, 3rd and 5th day after it. It is revealed that the surgery under intravenous anesthesia is associated with increase of coagulation potential and decrease of fibrinolytic activity that is the most marked on 3rd and 5th day.     

Transurethral prostatic resections under local anesthesia.

Standard transurethral prostatic resections were done on 18 patients with benign prostatic hyperplasia. Local anesthesia was used with standard 1 per cent lidocaine local infiltration of the prostate and topical instillation into the urethra. This anesthesia was supplemented in a few instances by modest doses of intravenous tranquilizers, which has proved to be a safe, simple and effective procedure.     

经尿道同期电切膀胱移行细胞癌合并前列腺增生的回顾性分析

目的评价膀胱移行细胞癌（transitional cell carcinoma,TCC）合并前列腺增生采取同期经尿道电切治疗的疗效。方法将患者分为A、B两组,A组25例实施单纯经尿道电切膀胱移行细胞癌,B组20例实施经尿道同期电切膀胱移行细胞癌及增生的前列腺,比较术后A、B两组间复发率、进展率、复发时间、膀胱颈部及前列腺窝复发率的差异。结论所有患者随访12～48个月,平均随访25.4个月。A、B两组术后肿瘤复发率、复发时间、进展率、膀胱颈部及前列腺窝复发率的比较差异无统计学意义（P〉0.05）。结论膀胱移行细胞癌合并前列腺增生实施同期经尿道电切术是可行的,与单纯电切膀胱移行细胞癌相比并不增加肿瘤的复发。     

经尿道等离子双极前列腺切除术与前列腺电切术的疗效比较

目的比较经尿道等离子体双极电切术(PKRP)与经尿道前列腺汽化电切术(TURP)治疗良性前列腺增生症(BPH)的临床疗效。方法将300例有症状的前列腺增生症(BPH)患者随机分成两组,各150例,分别行PKRP和TURP术,记录患者围手术期和术后3个月复查的有关指标(手术时间、术中出血量、冲洗时间、留管时间、住院时间,国际前列腺症状评分(IPSS),尿流率峰值(Qmax)和生活质量评分(QOL)),并发症(TURS、术中输血、继发出血、尿失禁、膀胱痉挛、尿道狭窄)发生率,对两组数据进行统计学分析。结果 PKRP组出血量、冲洗时间、留管时间和住院时间少于TURP组,两组相比差异有显著性(P0.05),术后3个月,两组患者症状评分、生活质量分析、最大尿流率均比术前明显改善(P0.05),PKRP组并发症发生率为3.3%,低于TURP组的13.3%,两组比较差异有统计学意义(P0.05),所有并发症对症处理恢复正常,两组均无死亡病例。结论 PKRP与TURP均是治疗BPH的有效术式,但PKRP较TURP并发症少,安全性高,是治疗BPH较理想的微创术式。     

Serum acid phosphatase elevation associated with transurethral resection syndromes

In 6 patients undergoing transurethral resection of the prostate for benign prostatic hyperplasia symptoms of post-transurethral prostate resection syndrome developed. Serum acid phosphatase determinations in the recovery room showed that all patients had high acid phosphatase levels although each had normal levels preoperatively. All patients showed a normal acid phosphatase level on the first postoperative day. The acid phosphatase elevations indicate significant intraoperative absorption of prostate tissue substances. The association of clinical symptoms with enzyme elevation suggests that the etiology of the confusing clinical syndromes following transurethral prostate surgery may be due to the intravenous absorption of not only irrigant solution but also tissue substances from the prostate gland.     

小功率钬激光前列腺剜除术在良性前列腺增生治疗中的临床价值

目的 评价小功率钬激光前列腺剜除术用于良性前列腺增生治疗中的临床价值.方法 选择2012年1月至2015年6月本院收治的良性前列腺增生患者312例,将患者随机分为两组,观察组为行小功率钬激光前列腺剜除术组,对照组为行经尿道前列腺电切术组,每组156例.比较两组手术时间、切除增生重量、术后血清Na+、血Hb、并发症、导尿管留置时间、住院时间以及术后最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)、血清前列腺特异性抗原(PSA).结果 两组患者围手术期指标结果显示,观察组切除标本重量、血清Na+、Hb、术后冲洗时间、尿管留置时间、术后住院时间及并发症等与对照组相比较,差异有统计学意义(P＜0.05);两组患者术后随访结果显示,观察组3、6及12个月的Qmax、IPSS、QOL及PSA与对照组相比较,差异均无统计学意义(P＞0.05).结论 小功率钬激光前列腺剜除术与经尿道前列腺电切术用于治疗良性前列腺增生疗效相当,且具有并发症发生率低的优点,值得在临床上推广应用.     

Survey of combined spinal-epidural anesthesia in Japan--analysis of questionnaire from 148 hospitals

Combined spinal-epidural anesthesia (CSEA) offers theoretic advantages especially for lower abdominal and limb surgery, because it produces the rapid onset of anesthesia and the proper muscle relaxation, with the option to extend the blockade with an epidural catheter. Whereas it is not known whether this anesthetic method is commonly used in clinical practice in Japan. We analyzed questionnaires on CSEA obtained form 148 hospitals. It was revealed that most anesthesiologists in Japan preferred general anesthesia with epidural block for lower abdominal surgery to CSEA. For lower limb surgery longer than 2 hrs, CSEA was employed in 57 hospitals (39%). CSEA was mainly used for orthopedics, obstetrics and gynecology and urology. Double needle double interspace method was commonly used rather than needle through needle method. In general, CSEA was not a widely performed anesthetic technic in Japan. CSEA should contribute to reduction of the incidence of postoperative nausea and vomiting caused by general anesthetics, and produce pre-emptive analgesia. We hope CSEA to be a common anesthetic procedure, although some disadvantages exist in training system for junior staff, national health insurance scheme and available local anesthetics in Japan.