12mm曲卡行膀胱造瘘在经尿道前列腺剜除术中的应用

目的 探讨12mm曲卡行膀胱造瘘制造低压膀胱在经尿道前列腺剜除术中的安全性和有效性.方法 回顾性分析2012年至2014年中山大学附属第三医院泌尿外科经尿道前列腺剜除术治疗前列腺增生患者35例,其中行膀胱造瘘者20例（造瘘组）,未行造瘘者15例（对照组）.总结分析两组的年龄、性别、体重、麻醉ASA分级、前列腺体积、术前PSA、术中血红蛋白下降值、手术时间、术中中心静脉压、输血率、术后膀胱冲洗时间、留置导尿时间和术后住院时间.造瘘组记录膀胱造瘘管留置时间.结果 两组的年龄、性别、体重和术前PSA均无统计学差异;造瘘组术前前列腺体积45～249ml,平均（107±52）ml,对照组术前前列腺体积24～126 ml,平均（65±31）ml（t=2.92,P＜ 0.05）;麻醉ASA分级（Ⅱ/Ⅲ）分别为7/13和14/1（x2=9.84,P＜ 0.05）.35例手术均顺利完成.造瘘组和对照组术中平均中心静脉压分别为（4.7±2.6） cmH2O和（7.6±4.2） cmH2O（t=2.56,P＜ 0.05）;留置导尿时间分别为112.9（64.2）h和184.5 （23.4）h（Z=3.13,P＜ 0.05）;术后住院时间分别为7.5 （1.8）d和9.0（3.0）d（Z=2.77,P＜0.05）;造瘘组膀胱造瘘管留置时间为68.4（65.8）h.两组术中血红蛋白下降值、手术时间、术后膀胱冲洗时间和输血率均无统计学差异.结论 12 mm曲卡膀胱造瘘制造低压膀胱联合经尿道前列腺剜除术,可使膀胱保持低压状态,降低手术时患者的中心静脉压,是安全、有效的手术方式.

The role of a 12 mm trocar cystostomy in transurethral enucleation and resection of prostate

Objective To evaluate efficacy and safety of the 12 mm trocar cystostomy in transurethral enucleation and resection of prostate （TUERP） for benign prostatic hyperplasia （BPH）.Methods Twenty patients who underwent ultrasound-guided 12 mm trocar cystostomy in TUERP for BPH （cystostomy group） and fifteen patients who only underwent TUERP （control group） were enrolled.The perioperative outcome data were compared.Early complications were recorded.Results No significant differences in age,gender,weight and serum prostate-specific antigen （PSA） were observed between the two groups.The mean prostate volume in the cystostomy group was larger than the control group before the surgery （107±52） ml VS（65 ±31） ml,t=2.92,P〈 0.05].The rate of third level American Society of Anesthesiologists score （ASA） were higher in the cystostomy group （Ⅱ/Ⅲ,7/13 VS 14/1,x 2=9.84,P〈 0.05）.All procedures were completed successfully.The cystostomy group associated with lower central venous pressure （CVP）,shorter catheterization time and shorter hospital stay （4.7±2.6） cmH2O VS （7.6±4.2） cmH2O,112.9 （64.2） h VS 184.5 （23.4） h,and 7.5 （1.8） d VS 9.0 （3.0） d,respectively,P〈 0.05 for all）].There was no significant differences in hemoglobin decrease,operative time,blood transfusion and irrigation time.Conclusion A 12 mm trocar cystostomy in TUERP is a safe,effective method for BPH,with lower bladder pressure and lower CVP during the surgery.