经尿道前列腺电汽化术的并发症及防治

目的　探讨经尿道前列腺电汽化术（ＴＶＰ） 术中及术后的常见并发症及产生原因,以提高ＴＶＰ 治疗效果。　方法　对３８０ 例有症状的良性前列腺增生（ＢＰＨ） 患者行ＴＶＰ 术。平均年龄６８－３ 岁。术前及术后测定血常规、血钠和血糖,术后随访１ ～３ 个月。　结果　本组无死亡率。术中平均出血８６ｍｌ,血常规、血钠及血糖变化不明显,发生经尿道电切综合征（ＴＵＲＳ） 先兆２ 例。术后尿道狭窄发生率为３－２％ ,继发性出血０－５ ％ ,尿路感染４－７ ％ ,阳萎２－３ ％ ,逆行射精４５－６ ％ ,无真性尿失禁。　结论　ＴＶＰ术中保持清晰的视野可预防ＴＵＲＳ 的发生。操作损伤是引起尿道狭窄的重要原因。术前控制尿路感染及保持前列腺窝内平整可减少尿路感染的发生     

耻骨上经膀胱手术与经尿道电切术治疗前列腺增生症的比较

目的 比较耻骨上经膀胱手术与经尿道前列腺电切术(TURP)治疗前列腺增生症术后尿失禁的发生情况.方法 将135例患者分为两组:82例行耻骨上经膀胱手术(SPP),53例行TURP.观察两组尿失禁的总发生率,按Stamey尿失禁分级系统观察严重程度、尿失禁持续时间,对持续1周以上者行尿动力学检查,分析其类型.结果 SPP组尿失禁的总发生率、严重程度、持续时间均高于TURP组,术后尿动力学分析发现,发生压力性尿失禁者SPP组高于TURP组,发生急迫性尿失禁者两组差异无统计学意义.结论 从预防术后尿失禁角度,TURP术优于sPP术.sPP术后发生压力性尿失禁多见,分析可能与手术切除彻底,且易损伤膜部尿道黏膜有关.     

减少耻骨后前列腺癌根治术并发症的临床研究

目的探讨减少耻骨后前列腺癌根治性切除术的并发症。方法采用集柬血管钳法保留尿道外括约肌及其神经支配、保留神经血管束（NBV）、耻骨前列腺韧带等方法行前列腺癌根治性切除术43例。结果经随访6～72个月，无尿失禁，39例排尿通畅，4例排尿困难，2例肿瘤复发。维持正常勃起功能者12例。结论保留尿道外括约肌、膀胱颈整形术可有效防止尿失禁发生率；保留NBV可有效保留性功能。     

耻骨上前列腺摘除术后排尿困难的原因与治疗(附22例报告)

报告自１９７２～１９９７年收治耻骨上前列腺摘除术后排尿困难者２２例，以探讨耻骨上前列腺摘除术后排尿困难的原因和治疗办法。其中后尿道狭窄１０例，尿道内口闭锁３例，后唇瓣膜２例，腺体残留２例，增生复发３例，前列腺癌２例。尿道狭窄是排尿困难的主要原因。经冷刀内切开治疗一次成功１１例，冷刀内切开失败改开放手术２例，开放手术４例。认为经尿道冷刀内切开是首选治疗方法     

Results of Three Dimensional Conformal Radiotherapy and Hormonal Therapy for Local Recurrence after Radical Prostatectomy

Background and Purpose: Analysis of treatment results of combined three–dimensional conformal radiotherapy (3DCRT) and hormonal therapy in patients with locally recurrent prostate cancer after radical prostatectomy.Patients and Methods: Between 1992 and 1998, 24 patients presented with a rising prostate–specific antigen (PSA) between 4 and 152 months following radical prostatectomy and a local recurrence demonstrated by imaging. Recurrence was biopsy–proven in 13 cases. All patients were treated with 3DCRT to a total dose of 60–70 Gy. 21 patients (88%) received adjuvant hormone therapy up to a maximum of 6 months.Results: All patients showed a response in PSA values after therapy. Median follow–up is 43 months. Overall survival is 80% and 67% at 3 and 5 years, respectively. Biochemical control rates are 53% and 38% at 3 and 5 years, respectively. 14 patients developed a second PSA relapse. Acute and late toxicities, classified with the RTOG score, were moderate.Conclusion: Radiotherapy and short–term adjuvant hormone therapy represent an effective and well–tolerated treatment for locally recurrent prostate cancer after radical prostatectomy resulting in good local control. Long–term prognosis in terms of biochemical control and disease–specific survival remains poor.     

改良的Madigan前列腺切除术

目的　对Madigan前列腺切除术 (MPC术 )进行改良 ,提高手术疗效。　方法　对 52例前列腺增生 (BPH)患者行MPC术 ,并进行手术改良。包括 :(1)显露膀胱颈及尿道起始部以避免或减少尿道损伤 ;(2 )联合膀胱顶部小切口以治疗中叶增生显著和 (或 )合并膀胱病变的BPH。结果　尿道完整或基本完整者 48例 ,术中出血较少 ,平均手术时间 12 0min。其中 3 5例获随访 ,随访时间 1～ 12个月 ,术后平均最大尿流率 18 9ml/s;8例患者手术前后行排尿期膀胱尿道造影 ,证实术后前列腺部尿道及膀胱颈完整 ,尿道较术前明显增宽。　结论　改良的MPC术减少了尿道损伤的发生 ,扩大了MPC术的适应证 ,手术操作简便、并发症少 ,疗效确切     

Use of complementary and alternative medicine by patients with localized prostate carcinoma: study at a single institute in Japan

Background: The use of complementary/alternative medicine (CAM) has recently received considerable attention throughout the world. We evaluated the prevalence and predictors of CAM use among Japanese patients with localized prostate cancer. Methods: A total of 177 patients with localized prostate carcinoma underwent radical retropubic prostatecotomy or external beam radiation therapy between January 1994 and January 2001. Of them, 138 (78%) answered a self-administered questionnaire on CAM use and were eligible for this study. The overall prevalence, types of CAM used, and costs of CAM were assessed. The effects of age, prostate-specific antigen (PSA) level, clinical stage, pretreatment Gleason score, patients' income, patients' final educational status, and general health-related quality of life at baseline and 1 year after treatment, as estimated using the European Organization for Research and Treatment of Cancer Prostate Cancer Quality of Life Questionnaire on the prevalence of CAM use, were evaluated. Results: Twenty-seven patients (20%) had once used or had been using some types of CAM. Herbal medicine and vitamins were the most common types of CAM used. Preoperative Gleason score was significantly associated with CAM use, as determined by the χ² test (P = 0.0198), and PSA level and posttreatment physical function domain were marginally associated with CAM use, as determined by the Mann-Whitney U-test (P = 0.0734 and P = 0.0597, respectively). Patient age, income, and final educational status had no impact on CAM use. Conclusion: A relatively small proportion of Japanese patients with localized prostate cancer have tried CAM compared with the proportions of patients described in previous reports from Western countries. Received: July 1, 2002 / Accepted: October 23, 2002 Acknowledgments We thank Mr. Masahiro Nanba for his assistance with data collection, and Dr. Yoji Wani for his pathologic review of specimens. Correspondence to:K. Yoshimura     

前列腺切除术后出血的预防及护理

前列腺切除术后出血是前列腺切除术后的主要并发症之一，处理不当，常可危及患者生命。作者介绍本院对此并发症采取的预防及护理措施，减轻了患者的痛苦，避免了危及生命的并发症，取得了良好的效果。     

前列腺摘除术后患者硬膜外自控镇痛的疗效观察

目的观察前列腺摘除术后布比卡因复合芬太尼硬膜外患者自控镇痛的临床效果。方法择期行前列腺摘除术患者80例,ASAⅠ～Ⅲ级,随机分成2组,Ⅰ组为对照组,术毕拔出硬膜外导管,回病房后根据患者疼痛情况分次肌注哌替啶1～1.5 mg/kg镇痛。Ⅱ组为硬膜外自控镇痛(PCEA)组,术毕接一次性镇痛泵,内含0.125%布比卡因 芬太尼0.4 mg 地塞米松10 mg共100 ml,以2 ml/h持续输注,PCA剂量为0.5 ml,锁定时间为15 min。观察术后48 h内两组的镇痛效果、切口引流量、发生膀胱痉挛痛的例数及术后1、2、6、12、24、48h血压、心率的变化。结果术后48 h内Ⅱ组镇痛效果明显优于Ⅰ组,切口引流量及发生膀胱痉挛痛的例数Ⅱ组明显少于Ⅰ组(P<0.01)。Ⅰ组患者术后各时点血压、心率较术前基础血压、心率明显升高、增快(P<0.05),Ⅱ组患者术后各时点血压、心率与术前基础值比较相对平稳(P>0.05)。结论布比卡因复合芬太尼硬膜外患者自控镇痛用于前列腺摘除术后镇痛效果好,能使术后患者血压、心率维持平稳,减少膀胱痉挛痛和创面出血量。     

经尿道前列腺电切术和汽化电切术并发症48例分析

目的分析经尿道前列腺电切术（TURP）与经尿道前列腺汽化电切术（TVP）术中、术后常见并发症的原因、预防及治疗,提高手术安全性和有效性。方法回顾分析1999年5月-2006年6月本院TURP和TVP术48例並发症患者的临床资料。结果平均手术时间75min,平均切除组织41g。术中、术后出血20例,电切综合征（TURS）5例,暂时性尿失禁11例,膀胱颈部挛缩5例,尿道狭窄8例,尿路感染7例,膀胱穿孔1例。结论TURP和TVP是良性前列腺增大症安全有效的外科治疗方法,术前详细采集病史,术中正确操作,术后对病人正确指导及处理可有效减少手术并发症。