保留尿道前列腺切除术的并发症及防治

目的：探讨保留尿道前列腺切除术常见并发症及产生原因，以提高其治疗效果。方法：对157例有症状的良性前列腺增生症（BPH）患者行保留尿道前列腺切除术。术后随访3个月－6年。结果：术中和术后并发症有尿道损伤105例，膀胱颈损伤12例。精囊损伤5例，术中大量出血达500ml2例，腺体残留1例，膀胱肿块残留1例，轻度尿失禁5例，尿道狭窄2例。结论：术前全面检查、术中致细操作、术后控制尿路感染可减少并发症的发生。     

经尿道前列腺电切术的并发症及其防治

报道经尿道前列腺电切术（ＴＵＲＰ）８７５例的临床资料，年龄４７～８７岁，平均６９．２岁。主要临床表现为进行性排尿困难，夜尿次数增多和尿潴留。术中术后常见并发症的发生率分别为：ＴＵＲ综合征２．７％，包膜穿孔和尿外渗１．７％，切破静脉窦而中止手术０．６％，术中出血和术后继发性出血３．９％，暂时性尿失禁３８％，永久性尿失禁０１％，排尿不畅和尿道狭窄２．１％，阳萎１２０％，逆行射精４５０％。对上述并发症的防治进行了讨论。     

耻骨后前列腺癌根治术（附27例报告）

目的总结经耻骨后前列腺癌根治术的治疗体会。方法2000年-2005年27例局限性前列腺癌患者，年龄60-71岁，平均66岁，术前PSA值4．8—37．5ng／mL。B期21例，G1期6例。采用开放性前列腺癌根治术治疗。结果本组患者高分化癌7例，中分化癌15例，低分化癌5例，术中出血300—1200mL，平均560mL，无周围脏器损伤及围手术期死亡病例，无吻合口漏尿。无吻合口狭窄、排尿困难，6例出现暂时性尿失禁，分别于术后1—2月恢复。9例术后1个月PSA降为0，随访未见升高，无需服用抗雄激素药物；其余18例患者间断性服用抗雄激素药物PSA下降至0．2ng／mL。术后16例维持阴茎勃起功能，所有病例均无瘤存活。结论耻骨后前列腺癌根治术中保留耻骨前列腺韧带及耻骨直肠悬带有助于减少并发症，取得较好的疗效。     

腹腔镜前列腺癌根治术治疗早期前列腺癌

目的：探讨腹腔镜前列腺癌根治术(LRP)治疗早期前列腺癌的疗效。方法：对30例T＼M分期T1b～T2期的前列腺癌患者，行腹腔镜下经腹途径LRP术。将30例按时间顺序分前、后两组，统计两组的手术时间、出血量、围手术期并发症，提出预防和处理并发症的措施。结果：30例手术均获成功。前、后两组平均手术时间分别为390和270min；平均出血量430和160ml。在前组(早期)发生耻骨后静脉丛损伤导致大出血3例，术中分离损伤膀胱5例，直肠损伤2例，术后出现尿外渗7例，出现膀胱尿道吻合口狭窄2例。后组1例出现尿外渗和1例直肠损伤。30例术后3周拔除尿管排尿通畅。术后复查PSA值小于0．3mg／L。结论：随着术式的改进和并发症的减少，LRP已成为我们治疗早期前列腺癌的标准术式之一。     

Madigan前列腺增生切除术

为了提高前列腺增生症的手术治疗效果，采用Ｍａｄｉｇａｎ手术治疗前列腺增生症患者２５例。１５例尿道完整，１０例损伤尿道缝合修复；术后出血少、恢复快；随访４～２５个月，无尿道狭窄、尿失禁等并发症。对手术优点、术中注意事项及适应证的选择进行了讨论。     

十二指肠损伤的诊断和处理

十二指肠损伤是一种严重的创伤。十二指肠位置特殊，处理复杂，术后并发症多，死亡率高，不及时处理或处理不当会引起死亡犤１犦。本组１９８０年１月至２００１年１２月收治十二指肠损伤４３例，处理体会如下。临床资料１．一般资料：本组４３例，男３１例，女１２例；年龄７～６６岁，平均３３．４岁。发现至手术时间１０分钟～４８小时。２．损伤原因：（１）医源性损伤１４例：其中EST术后２例，胆道手术９例，腹腔镜手术２例，胃手术１例；（２）闭合性损伤２２例：其中车祸伤１６例，坠落伤４例，挤压伤２例；（３）开放性损伤６例…     

高龄患者腹腔镜下行前列腺癌根治性切除术围手术期并发症及预后研究

目的 探讨高龄患者行腹腔镜前列腺根治性切除术（LRP）围手术期并发症发生及预后。方法 选取2012年1月至2017年12月在本院收治的116例高龄前列腺癌（PCa）患者（≥75岁），均行LRP术，分析围手术期发生并发症、手术时间、术中出血量和术后住院时间等情况。围手术期并发症定义为术后30 d内发生的并发症。结果 平均手术时间175.8 min，平均出血量154.7 mL。术后平均住院时间15.9 d。围手术期并发症发生率33.6%（39例），包括尿漏、尿路感染、肺炎、下肢静脉血栓、肺栓塞等。结论 LRP术仍有较高的并发症发生率，术前应积极治疗基础疾病，术中严格操作，术后采取相应预防措施以防止出现严重并发症，并根据患者情况选择合适的治疗方案。     

快捷耻骨上前列腺摘除术的初步经验

耻骨上前列腺摘除术是一种常用手术，为缩短手术时间、减少术中出血、降低术后并发症，我们揉合各家之长，摒弃一些不必要步骤，已使手术时间缩短至近半小时，现介绍如下。临床资料自１９９２年１月～１９９４年８月间共行耻骨上前列腺摘除术７８例。年龄５６～９６岁，平...     

前列腺选择性光汽化术治疗高龄高危良性前列腺增生

目的探讨前列腺选择性光汽化术（PVP）治疗高龄高危良性前列腺增生（BPH）的安全性和有效性。方法采用骶管麻醉应用PVP术治疗78例BPH患者，年龄70-94岁，平均82岁。观察术中骶麻效果、手术时间、出血情况、术后留置尿管时间以及手术前后残余尿量和尿流率变化。术后随访6—16个月。结果除1例骶麻效果不佳合用静脉复合麻醉外，其余77例均采用骶麻，手术时间20—100min，平均45min，术中几乎无出血，无输血病例。术后7例未留置尿管，余7l例留置尿管24—48h，平均32h，其中拔除尿管后1例出现尿潴留，1例因过度活动导致迟发性出血，2例有膀胱刺激症状，无尿失禁等并发症。结论PVP术治疗BPH安全、有效、并发症极少，适合于高龄高危患者。     

减少腹腔镜前列腺癌根治术围术期并发症的体会

目的：探讨腹腔镜前列腺癌根治术的手术技巧及改进方法,以减少该术式围术期并发症的发生.方法：回顾性分析54例接受腹腔镜前列腺癌根治术患者临床资料：年龄58～76岁,中位年龄68岁.前列腺特异抗原（PSA）为1.6～40.6 ng/ml.Gleason评分≤8分.术前病理检查证实为前列腺癌.均作手术治疗.结果：平均手术时间233（120～425）min,平均出血量335（100～800）ml.术后输尿管损伤1例,直肠损伤1例,尿漏6例,均自愈.术后出现不同程度尿失禁12例,6个月内恢复尿控.术后病理检查切缘阳性8例.随访42例,随访时间为1～36个月,无尿道狭窄.结论：有效控制背深静脉丛,精细解剖前列腺尖部,保护尿控神经,良好吻合尿道膀胱等,能有效地减少腹腔镜前列腺痛根治术围术期并发症的发生.     

经尿道前列腺气化术治疗前列腺增生症(附59例报告)

为寻求更安全而有效治疗良性前列腺增生症（BPH）的方法，采用经尿道前列腺气化术（TUVP）治疗BPH59例。结果经尿流改道和充分术前准备后行TUVP，能安全有效地解除前列腺尿道的梗阻，59例排尿功能均恢复良好。3例于术后2年出现尿潴留症状。认为TUVP损伤小、安全性高、疗效确切且并发症少，尤其适用于有严重并发症的高危患者的治疗。     

Immunohistochemical finding of α-1-antichymotrypsin in tissues of benign prostatic hyperplasia and prostate cancer

BACKGROUND: Ratio of free to total (F/T) prostate-specific antigen (PSA) is higher in the blood of patients with benign prostatic hyperplasia than those with prostate cancer. To clarify the difference between ratios in these two, alpha-1-antichymotrypsin, the major component of the bound PSA in the blood, was immunohistochemically examined. METHODS: Tissues were obtained surgically via a retropubic approach from patients with benign prostatic hyperplasia (nine cases) and prostate cancer (27 cases). These samples were processed in paraffin blocks, cut into 5 mm sections and stained with antibodies against alpha-1-antichymotrypsin and PSA. RESULTS: The percentage of alpha-1-antichymotrypsin-stained cells in prostate cancer was higher than that in benign prostatic hyperplasia (P<0.05). Almost all of glandular and cancer cells were stained with PSA antibody. The percentage of alpha-1-antichymotrypsin-stained cells in prostate cancer did not correlate to histologic grade, although alpha-1-antichymotrypsin-stained cells were more widely scattered in high grade tissues. No correlation was found between alpha-1-antichymotrypsin-stained cells and ratio of F/T in the blood of cancer patients. In about 20% of cancer tissues, histiocytes with positive alpha-1-antichymotrypsin staining were found in stroma but not in that of benign prostatic hyperplasia. CONCLUSIONS: Prostate cancer tissues are shown to have a richer environment of alpha-1-antichymotrypsin than those of benign prostatic hyperplasia. Some cancer tissues contained alpha-1-antichymotrypsin-stained histiocytes. These local events may correlate to a high amount of the bound form among total PSA in the blood of prostate cancer patients.     

尿动力与前列腺增生关系的定量化研究

目的 观察探讨前列腺增生患者尿动力学特点,总结尿动力与前列腺增生的关系.方法 选取本院2013年3月至2014年11月收纳的98例前列腺增生症患者,均留置尿管进行尿动力学检查.一周后按是否存在逼尿肌过度活动现象分为观察组和对照组.观察组为逼尿肌过度活动的前列腺增生患者,对照组为无逼尿肌过度活动的前列腺增生患者,各49例.分析尿流动力学参数中最大逼尿肌压力等指标差异,总结尿动力与前列腺增生关系的定量化关系.结果 AUCdet/Vol诊断相较于传统方法的准确率为67例,即符合率为68.38％ (67/98),其中诊断出无梗阻的几率为90％(27/30),可疑梗阻的几率为42.30％ (11/26),梗阻的几率为69.04％ (29/42).诊断出无梗阻几率高于可疑梗阻及梗阻,差异有统计学意义(P＜0.05).两组患者尿动力学参数在最大逼尿肌压力(cmH2O)、直线被动尿道阻力梗阻分级、初始感觉时膀胱容量(mL)、膀胱顺应值、测量容积(mL)具有明显差异,有统计学意义(P＜0.05).结论 尿动力学检查可明确前列腺增生患者膀胱功能状态,逼尿肌过度活动的患者膀胱容量、尿道阻力关系及梗阻程度均大于非过度活动组患者.前列腺增生患者进行尿动力检查,有利于提前防治膀胱出口梗阻引起的急性尿潴留等情况,及早恢复膀胱功能及减轻患者尿路功能损害.     

构建三通道碎石系统处理合并前列腺增生的复杂性膀胱结石

目的 探讨一种新型碎石模式的构建及处理合并前列腺增生的复杂性膀胱结石的临床效果.方法 以电切镜鞘、肾镜镜鞘、膀胱侧视镜构建出三通道碎石系统,结合气压弹道碎石治疗42例合并前列腺增生的复杂性膀胱结石,比较碎石效果及术前、术后3个月I-PSS、QOL评分、BOO分级、Qmax差异.结果 42例患者均一次清石成功,碎石时间（43.6±11.2） min;无膀胱穿孔、明显水外渗、大出血、严重尿道损伤等并发症;顺利进行进一步经尿道前列腺电切术.术后3月I-PSS评分（9.5±3.6）分,QOL评分（1.3±1.2）分,Qmax（17.7±5.9） mL,以及BOO分级与术前比较差异均有统计学意义.结论 电切镜鞘、肾镜镜鞘及膀胱侧视镜构建出的三通道碎石系统可以连续高效地处理合并前列腺增生的复杂性膀胱结石,临床效果良好.     

Magnetic resonance imaging in the diagnosis of prostatic carcinoma and benign hyperplasia

Using a 0.5 tesla superconducting magnetic system, magnetic resonance imaging (MRI) studies were performed in 42 patients (27 prostatic carcinoma and 15 benign prostatic hyperplasia) and 2 healthy volunteers. Spin echo images were produced in the transverse, coronal and sagittal directions. T1 and T2 relaxation times were calculated from these images. The images of 2 normal prostates showed 2 separate zones: an internal zone and an external zone. The images of 8 of the 15 prostates with benign prostatic hyperplasia showed 3 zones: an internal zone, a band of low intensity and an external zone. Most of the cases of prostatic carcinoma showed extracapsular extension, so we could not detect zonal distinction of the images in 25 cases out of the 27 prostates with prostatic carcinoma. Most of the images of prostates with prostatic carcinoma showed irregular and asymmetric shape and inhomogeneous signal intensity. MRI had an accuracy of 85.7% in differentiating prostatic carcinoma from benign prostatic hyperplasia. A good correlation (r = 0.936) was observed between the weight of the whole prostate as predicted by MRI and the actual weight of the adenoma enucleated by retropubic prostatectomy. The change in volume of the prostate after hormone therapy was well evaluated by MRI. We were not able to differentiate prostatic carcinoma from benign prostatic hyperplasia on the basis of the T1 and T2 relaxation times alone. The serial measurements of the T1 and T2 relaxation times might be value in following therapeutic response of prostatic carcinoma.     

Holmium laser enucleation of the prostate: the safety, efficacy, and learning experience in China

PURPOSE: Holmium laser enucleation of the prostate (HoLEP) is a well established procedure for the treatment of benign prostatic hyperplasia. Here we report our experience of the learning curve, efficacy, and safety of HoLEP. METHODS: We retrospectively reviewed data from 190 consecutive patients who had undergone HoLEP for benign prostatic hyperplasia. The patients were divided into three groups: group 1--patients 1 to 50; group 2--patients 51 to 100; and group 3--patients 101 to 190. This analysis included our initial experience with the technique reflecting our learning curve. All patients were assessed preoperatively and 12 months postoperatively. Patient baseline characteristics, perioperative data, and postoperative outcome were compared in the three groups. All complications were noted. RESULTS: HoLEP resulted in a significant improvement in voiding symptoms and urodynamic parameters. The improvements in peak urinary flow rate, post-void residual urine, International Prostate Symptom Score, and quality-of-life index did not change significantly as experience increased. However, the operative time decreased significantly as experience increased. The surgeon became more confident with the HoLEP technique after about 15 cases in those with moderate-sized prostates. The postoperative rates for complications such as bladder mucosal injury, recatheterization and transient urinary incontinence were higher in group 1 than in the other two groups. CONCLUSIONS: Holmium laser enucleation of the prostate is a safe and effective treatment option for benign prostatic hyperplasia, even when performed by inexperienced surgeons. The incidence of complications decreases with increasing experience with the procedure.     

形状记忆合金网状支架治疗良性高危前列腺增生症

目的 探讨形状记忆合金网状支架治疗良性高危前列腺增生症的疗效。方法 回顾分析1995年11月至1998年11月应用镍钛形状记忆合金网状支架治疗高危前列腺增生症35例临床资料。结果 34例一次治疗成功,30例术后立即自行排尿,4例术后3天恢复自主排尿,总有效率97．1％(34／35)。结论 镍钛形状记忆合金网状支架治疗前列腺增生症安全、有效、近期疗效满意,远期疗效正在观察中。     

Phyllodes type of atypical prostatic hyperplasia: a report of 3 new cases

We report 3 new cases of phyllodes type of atypical prostatic hyperplasia. This lesion is characterized by epithelial and stromal proliferation. Stromal changes are the most characteristic finding in phyllodes type of atypical prostatic hyperplasia, which show atypical cells with enlarged, hyperchromatic sarcomatoid nuclei. Mitotic figures are not present. Although the histological appearance may mimic that of cystosarcoma phyllodes of the breast, this pattern is present only focally or not at all in phyllodes type of atypical prostatic hyperplasia. On computerized tomographic imaging phyllodes type of atypical prostatic hyperplasia has a distinct appearance. These patients can be expected to have a benign clinical course and distant metastases have not been reported. Treatment is by surgical excision as in benign prostatic hyperplasia.     

经尿道剜除联合电切治疗前列腺增生症402例临床分析

目的 探讨经尿道剜除联合电切术治疗前列腺增生症的疗效与并发症.方法 回顾分析本院2004年4月～2009年10月收治的402例前列腺增生患者,采用经尿道剜除联合电切术治疗过程、疗效及手术并发症等资料.结果 全组无死亡及水中毒(TURS综合症)病例,手术前后比较:IPSS评分、最大尿流率及残余尿量数值经统计学计算,均p<...