经尿道前列腺电切术患者转开放手术的危险因素分析

目的:分析经尿道前列腺电切术(TURP)转开放手术的危险因素,为选择正确的手术方式提供依据。方法:采用回顾性临床研究方法,对1997年1月~2005年3月接受TURP手术的1086例患者的人口统计学、临床病史、实验室检查、超声检查和术中并发症等11个危险因素进行研究,并进一步对这些参数与TURP转开放手术的相关性进行了多因素logistic回归分析。结果:39例(3.59%)患者接受了转开放手术。无法控制的出血为转开放手术主要原因(28例,71.79%)。在多因素分析中,前列腺体积>85.2 ml(OR=2.568,P<0.01)、切透前列腺外科包膜(OR=1.916,P<0.01)及中段尿白细胞计数>13.5个/HP(OR=1.486,P<0.01)与转开放手术呈相关性。结论:前列腺体积巨大和术中切透前列腺包膜是TURP转开放手术的危险因素;术中无法控制的出血、手术视野不清和前列腺体积大是TURP转开放手术的主要原因。

Predictive Factors for Conversion of Transurethral Resection of the Prostate to Open Prostatectomy

Objective: To evaluate the factors for the conversion of transurethral resection of the prostate(TURP) to open prostatectomy and to provide clinical evidence for surgical options.Methods: From January 1997 to March 2005,we performed 1 086 TURP and made retrospective analyses of 11 risk factors concerning the demographics,clinical history, laboratory data,ultrasound results,and intraoperative complications of the patients.In addition,multivariate logistic regression was used to determine those variables predicting the conversion of TURP.Results: Thirty-nine(3.59%) of the TURP cases required conversion,mostly because of uncontrollable hemorrhage(71.79%).Multivariate analyses showed that a prostate volume>85.2 ml(OR =2.568,P<0.01),intraoperative slit of capsula prostatica(OR =1.916,P<0.01)and a second midstream bladder specimen(VB2) white blood cell count of the urine >13.5/HP(OR=1.486,P<0.01) predicted the conversion to open prostatectomy.Conclusion: Benign prostatic hyperplasia(BPH) patients with a huge prostate and those with intraoperative slit of capsula prostatica undergoing TURP are more likely to be converted.And uncontrollable hemorrhage,huge prostate and poor endoscopic vision are the major reasons for the conversion.