经尿道前列腺电切术中包膜穿孔的临床分析

目的 探讨良性前列腺增生(BPH)经尿道前列腺电切(TURP)术中包膜穿孔的原因及防治措施.方法 对2002年2月至2011年2月行TURP术的893例患者的临床资料进行回顾性分析.结果 893例患者中,并发包膜穿孔16例,有覆盖的穿孔10例,游离穿孔3例,三角下穿孔3例.6例有明显冲洗液外渗,10例并发经尿道电切综合征(TURS)或TURS先兆.2例终止手术2周后二期行TURP手术;2例中转行耻骨上经膀胱前列腺摘除术;12例降低冲洗压力继续手术.术后大出血2例,行开放手术止血.所有患者均痊愈出院.结论 TURP过程中出现包膜穿孔,需及时正确判断包膜穿孔的类型和程度,给予相应处理,并注意TURS的预防、治疗.彻底止血、视野清晰及解剖结构清楚能明显降低穿孔的发生率.

Clinical analysis of capsular perforation in transurethral resection of prostate

Objective To investigate the causes and managements of capsular perforation in transurethral resection of prostate(TURP) for benign prostatic hyperplasia (BPH). Methods Clinical data of 893 cases who received TURP from February 2002 to February 2011 were analyzed retrospectively.Results In 893 cases, capsular perforation in 16 cases, among them, tissue covered perforation in 10 cases, dissociative perforation in 3 cases, perforation under bladder trignne in 3 cases. Six cases occurred with obviously extravasation, 10 cases with transurethral resection syndrome (TURS) or omen of TURS. Two cases were ceased operation and received TURP again after 2 weeks, 2 cases transferred to open surgery suprapubic prostatectomy, 12 cases kept up operation with lower bladder douche pressure. Two cases with postoperatire bleeding underwent open surgery hemostasis cured. All cases were discharged from hospital after recovery. Conclusions The type and extent of capsule perforation must be judged correctly,corresponding treatment must be given, prevention and treatment of TURS must be taken notice of, if capsule perforation occurs when TURP operation in progress. Less haematoma, clearview and normal anatomic structures can decrease the incidence of perforation.