前列腺切除术后大出血的原因和处理

目的：探讨前列腺切除术后大出血的原因和防治对策。方法：对本院1981年1月－2000年12月行前列腺切除术的758例患者临床资料进行回顾性分析。结果：758例患者中，25例术后发生大出血，其中术后早期出血16例，迟发性出血9例。18例经保守治疗治愈，3例经再次开放手术止血，4例经电切镜止血。结论：术中止血确切及术后保证引流通畅是预防前列腺切除术后大出血的关键；术后及时发现出血并正确处理可避免再次手术之苦；对膀胱内已充满血块不能吸出者需再次手术；电切镜下止血是一种安全而有效的方法。

Prevention and management of severe post-prostatectomy hemorrhage

Purpose:To investigate the causes and the management of severe post prostatectomy bleeding. Methods:Data of open prostatectomies for patients with benign prostatic hyperplasia (BPH) was reviewed retrospectively. Results:A series of 785 consecutive men (mean age 71 years) with benign prostatic hyperplasia received open prostatectomy between January 1981 and December 2000 in our hospital, of which 25 had severe post-prostatectomy hemorrhage. Early bleeding occurred in 16 patients and late bleeding in 9. Among these patients, 18 underwent conservative treatment, 3 needed reexploration to achieve hemostasis, and the rest 4 received endoscopic cautery techniques. Conclusions:Definite intraoperative hemostasis and postoperation care focused on monitoring the patient for catheter patency can effectively prevent post prostatectomy hemorrhage. Managed properly, most patients could stop bleeding without reexploration. Reexploration is generally reserved for severe refractory cases involving ongoing hemorrhage and clot retention. Endoscopic cautery technique offers a safe and an efficient method of delivering hemostasis.