膀胱微穿刺造瘘低压灌注在TURP中的应用

目的：探讨膀胱微穿刺造瘘低压灌注方法在经尿道前列腺电切术（TURP）治疗重度前列腺增生症（BPH）的疗效与安全性。方法：未行膀胱微穿刺造瘘的TURP治疗重度BPH52例为A组,行膀胱微穿刺造瘘的TURP治疗重度BPH58例为B组,通过比较术中出血量,前列腺切除重量,术中心率和血压变化情况,静脉血清钠下降值,评价两种方法的安全性,通过比较术后3个月最大尿流率（Qmax）、残余尿（RU）、国际前列腺症状评分（IPSS）,生活质量评分（QOL）,评价两种方法的疗效,并比较术后出血,尿道狭窄,拔管后排尿困难等术后并发症。结果：B组术中出血量,冲洗液吸收量,术中心率和血压变化情况,静脉血清钠下降值均低于A组,差异有显著意义,术后3个月两组Qmax、RU、IPSS、QOL较术前均明显改善,且差异有显著意义,两组间术后并发症比较无显著差异。结论：TURP术中行膀胱微穿刺造瘘出血少,冲洗液吸收量少,血压和心率变化小,血清钠浓度降低不明显,不增加术后并发症,能显著增加患者的手术安全性,适用于重度BPH的手术治疗。

Application of Low Pressure Irrigation with Suprapubic Mini--cystostomy in TURP

Objective. To evaluate the efficacy and safety of transurethral prostatectomy with suprapubic mini-cystostomy in treating the benign prostatic hyperplasia （BPH）. Methods： 52 patients （A group） with BPH who underwent TURP without bladder suprapubic mini-cystostomy and 58 patients （B group） with BPH who underwent TURP with suprapubic minicystostomy were compared. Safety was assessed by comparing the blood loss, weight of reseeted prostate tissue, changes in heart rate and blood pressure between two groups during operation. Efficacy was assessed by investigate the maximum urinary flow rate （Qmax）, residual urine volume （RUV）, IPSS score and QOL score 3 months after operation. Differences of post- operative complication rates including bleeding, stenosis of urethra and dysuria after catheter removal were also compared. Results： B group had less blood loss, less fluid absorbed and less change in heart rate, blood pressure and serum sodium during operation when compared to A group, the difference was statistically significant. Both groups showed significant improved Qmax. RU, IPSS and QOL scores 3 months after operation. However, there was no significantly difference in the post-operative complication rate between two groups. Conclusion： TURP with bladder suprapubic mini-cystostomy is effective and safe, especially for patients with large prostate.