90岁以上高龄前列腺增生患者经尿道前列腺电切术的围手术期处理(附25例报道)

目的总结90岁以上前列腺增生(BPH)经尿道前列腺电切术(TURP)的临床经验，提出该手术围手术期处理的特别措施，减少手术并发症，降低死亡率。方法1995年1月至2004年12月对25例90岁以上高龄BPH患者行TURP，年龄90～93岁，平均为90．23岁。其中23例患者认知能力正常，2例合并有老年痴呆。5例合并严重的血尿，7例合并膀胱结石，11例慢性尿潴留拒绝留置导尿管或膀胱造瘘管。20例于连续低位硬膜外麻醉下行TURP，5例于全麻下行手术。结果手术时间5～45min，平均为19．4min；电切前列腺组织称重15～71g，平均为28．9g；出血量30～220ml，平均为105ml。25例中4例术中在无严重出血的情况下出现生命体征紊乱，21例顺利度过手术期。术后未发生严重的并发症，48～72h拔导尿管，22例排尿通畅；3例尿潴留，留置导尿。结论严密的围手术期保护、电切时间短是手术成功的关键。对90岁以上高龄BPH患者而言，TURP是安全的手术方法。

Transurethral resection of prostate, its perioperative management in 90 years older benign prostatic hypertrophy patients (report of 25 cases)

Objective To summarize our clinical experience of transurethral resection prostate(TURP) in 90 years old patients with benign prostatic hypertrophy(BPH),and to introduce our special measures to reduce the operative complications and mortality.Methods From Jan 1995 to Dec 2004, 25 cases of elderly patients were performed TURP, age ranged 90-93 years, average 90.23 years. Among these patients,23 possessed normal cognition, 2 with senile dementia. 5 with severe hematuria. 7 complicated by bladder stone, 11 with chronic urinary retention refusing catheterization or cystostomy. 20 cases were operated under low epidural anesthesia, the other 5 under general anesthesia.Results Operation durations were 5-45 min, average 19.4 min. The resected prostatic tissue weighed 15-71 grams, average 28.9 grams. Blood loss was 30-220 ml, average 105 ml. Of all patients, 21 cases stood the operation well, 4 cases showed disturbed vital signs in absence of severe blood loss. No severe complication occurred postoperatively. The catheter was with drawn at 48-72 h with 22 patients passing urine easily and smoothly and 3 still suffering urine retention with indwelled catheter.Conclusion Good perioperative protection and short operative duration are key for the success of the TURP, safe and effective for elderly patients with BPH.