高频电在经尿道手术应用中相关问题的探讨(附1 665例报告)

目的：探讨高频电在经尿道手术中的作用原理、适应证、电极配置及神经肌肉刺激等相关问题。方法：开展经尿道高频电手术1665例，其中TURP 468例、TUVP 227例、TUEVAP 341例，TURBT 527例．TUIBN 102例。采用高频发生器为Storz TUR 27810或Vally Lab Froce FX，输出电流频率395～450kHz。结果：手术时间TURP、TUVP、TUEVAP之间差异无显著性（P〉0.05）；术后拔管时间TURP与TUVP、TUEVAP，差异有统计学意义（P〈0.05）；术后继发出血TURP组17例、TUEVAP组2例；TURP发生TURS，先兆2例；TURBT49例、TUEVAP24例发生闭孔神经反射；1例返回电极灼伤，3例置心脏起搏器者及4例置金属股骨头者手术未发生高频电意外。结论：调制及匹配最佳的高频电频率及输出功率可产生最佳的电灼、脱水、汽化效应，应注意手术电极及返回电极的意外损伤，对高频电流产生的低频刺激电流引起神经肌肉刺激（闭孔神经反射）要注意防范。

High-frequency electric current in the transurethral operations (Reprot of 1 665 cases)

Objective:To discuss the mechanism,indication,electrode equipment,neurostimulation and so on in the transurethral operations by using high-frequency electric current.Methods:A total of 1 665 cases were operated on with using high-frequency electric current.Among them,468 cases were operated by TURP,227 cases by transurethral vaporization of the prostate(TUVP),341 cases by transurethral electrovaporization-ablation prostatectomy(TUEVAP),527 cases by TURBT,and 102 cases by TUIBN.The high-frequency generators,Storz TUR27810or Vally Lab Froce Fx were used in these operations and output frequency was 395-450 kHz.Results:The operation time among TURP,TUVP and TUEVAP groups has insignificant difference(P>0.05).The time indwelling catheterization has significant difference(P>0.05).There were 17 cases of second bleeding after TURP,2 cases after TUEVAP,2 cases having the precedence of transurethral resection syndrome(TURS)in the TURP group,24 cases in TUEVAP group and 49 cases in TURBT group having obturator nerve reflectivity,3 cases with heart pacemaker and 4 cases with metals femoral head who didn't take place the high-frequency current accident.Conclusions:The accurate modulation of the current frequency and output power can produce better effect of electrocoagulation,dehydration and vaporization.But we must pay attention to the accident injury of electrodes and precaution to the nerve and muscle stimulation(obturator nerve reflectivity)caused by low-frequency electric current.