急诊经尿道前列腺电切术的临床应用

目的探讨急诊经尿道前列腺电切术（transurethral resection of prostatic,TURP）在治疗有急诊手术指征的前列腺增生（benign prostatic hyperplasia,BPH）中的应用。方法2000年1月～2007年12月我院急诊TURP治疗BPH37例,术前给予降压、降糖等治疗,合并膀胱结石者同时碎石。结果无输血、手术死亡、大出血及经尿道电切综合征等发生。术中出血量100～400 ml,平均180 ml。35例术后病理证实为前列腺增生,2例为C期前列腺癌,进一步行双侧睾丸切除术及间断雄激素阻断治疗,随访12个月,排尿通畅,前列腺特异性抗原0～4 ng/ml。拔出尿管后均排尿通畅。3例术后1～3个月出现尿道狭窄,经定期尿道扩张3个月后治愈。37例随访3～24个月,平均9个月,术前后最大尿流率（8.2±3.3）ml/s vs（19.3±3.1）ml/s,t=-5.435,P=0.000],IPSS评分（22.5±5.1）分vs（5.3±1.2）分,t=7.136,P=0.000],QOL评分（4.5±1.1）分vs（2.0±0.7）分,t=2.494,P=0.000]均有统计学差异。结论急诊TURP治疗有急诊手术指征的BPH,效果满意。但急诊TURP治疗BPH,为一种非常规的治疗方法,麻醉与手术风险较大,要求成熟的有经验的医师操作,并注意前列腺偶发癌的可能。

Transurethrai Resection of the Prostate in Emergency Treatment

Objective To investigate the effect of transurethral resection of prostate（TURP） on patients with benign prostatic hyperplasia （BPH） in emergency treatment. Methods A total of 37 cases of BPH were treated emergently with TURP in our hospital from January 2000 to December 2007. The blood pressure and serum glucose of the patients were controlled before the procedure. Litbotripsy was performed on the cases with bladder stones. Results In our patients, no blood transfusion, surgeryrelated death, massive hemorrhage, or transurethral resection syndrome occurred. The blood loss ranged from 100 to 400 ml with a mean of 180. BPH was confirmed by pathological examination after the operation. Two patients were diagnosed as having prostatic cancer and thus received bilateral testectomy and intermittent androgen deprivation therapy. The two patients were followed up for 12 months; during the period none of them had dysuria, and laboratory examination showed the level of specific prostatic antigen ranged from 0 to 4 ng/ml. In the other patients, 3 developed urinary stricture in 1 to 3 months after the treatment, and then was cured by dilating the urinary tract regularly for 3 months. A mean of 9-month （3 to 24） follow-up was available in our patients. The reexamination carried out during the follow-up sowed that the maximum urine flow rate increased （8.2 ±3.3） ml/s vs （19.3 ± 3. 1 ） ml/s,t= -5.435, P=0. 000]and the IPSS （22.5±5. 1） vs （5.3 ±1.2）, t =7. 136, P=0. 000] and QOL （4.5 ±1.1） vs （2. 0 ± 0.7 ） , t = 2. 494, P = 0. 000 ] scores decreased significantly after the operation. Conclusions For the BPH patients with indications for emergency treatment, TURP is effective. However, the operation should be performed by experienced surgeons since it is not a regular treatment. Prostatic cancer should be excluded during the operation.