良性前列腺增生术后再入院的原因及治疗探讨(附106例报告)

目的　分析良性前列腺增生 (BPH)切除术后患者再入院的原因 ,探讨治疗方法。　方法　BPH术后再入院患者 10 6例。腺体残留或复发者 4 7例 ,其中TURP术后 4 1例 ,开放术后 6例 ,4 2例再次行TURP ,5例因腺体较大行开放手术 ;尿道狭窄者 32例 ,其中TURP术后 12例 ,开放手术后 2 0例 ,2 7例行经尿道瘢痕组织冷刀内切开术加电切术 ,3例行尿道外口成形术 ,2例行耻骨上膀胱造瘘术 ;TURP术后继发出血 11例 ,行经尿道膀胱冲洗加电凝止血 ;神经原性膀胱功能障碍 7例 ,2例行膀胱颈环状肌切断术 ,3例自行间断导尿 ,2例行耻骨上膀胱造瘘术 ;前列腺癌 6例 ,1例行前列腺癌根治术 ,3例行姑息性TURP加睾丸切除术 ,2例行睾丸切除术 ;TURP术后尿失禁 2例 ,1例使用阴茎集尿器 ,1例转外院行尿道生物胶原注射缩窄尿道 ;腹壁切口疝 1例 ,行疝修补术。　结果　 10 6例患者 ,97例行手术治疗 ,术后随诊 6个月～ 15年 ,平均 5年 8个月。效果满意 84例 (86 .6 % ) ;9例尿道狭窄术后需要定期尿道扩张 ;2例尿道狭窄和 2例神经原性膀胱功能障碍手术失败 ,行耻骨上膀胱造瘘。9例未行手术治疗。　结论　术前准确诊断 ,合理选择手术方式及术中术后正确处理是预防患者再次入院的关键。再次手术应首选经尿道方式。

Causes and management of readmission after prostatectomy for BPH ( report of 106 cases)

Objective To explore the causes of readmission after prostatectomy for BPH and to discuss the treatment approaches. Methods A total of 106 cases who were eligible for the study were reviewed.47 cases had residual and recurrent adenoma;of these cases,42 underwent TURP and 5 open prostatectomy again.32 cases developed urethral stricture;of these cases 27 underwent transurethral cold knife incision plus electric resection of scar and 3 urethral orifice reconstruction and 2 suprapubic cystostomy.11 cases who had experienced bleeding after TURP underwent transurethral bladder washing and coagulating.7 cases had neuropathic bladder dysfunction;of these cases 2 underwent transurethral bladder neck circle muscle resection,3 intermittent self-catheterization and 2 suprapubic cystostomy.6 cases had prostatic cancer;of these cases 1 underwent radical prostatectomy,3 palliative TURP plus orchiectomy and 2 orchiectomy.2 cases had incontinence after TURP;of the 2 cases 1 used external collecting device and 1 was transfered to other hospital for surgery.1 case had abdominal incision hernia and then underwent hernia repair. Results Among 106 cases, 97 cases underwent operations and of them 84 (86.6%) cases achieved successful results.The follow-up time was 6 months to 15 years with a mean of 5 years and 8 months.9 cases with urethral stricture required regular urethral dilation after surgery.4 cases who had had unsuccessful surgery underwent suprapubic cystostomy.Other 9 cases did not undergo operations due to poor health and other reasons. Conclusions Correct preoperative diagnosis, rational surgical type and adequate intraoperative and postoperative management are key to preventing readmission. Transurethral surgery is most favorable treatment choice for readmitted patients after prostatectomy for BPH.