电切综合征的防治(附2335例报告)

目的:探讨经尿道电切术(transurethral resection,TUR)所致电切综合征(TURS)的特点及防治方法。方法:回顾性分析我院1989～2010年施行的2 335例TUR所致63例TURS患者的临床资料,分析术中发生TURS的特点、与手术操作的关系及防治措施。结果:第一阶段经尿道电切手术120例中,发生TURS者14例(11.67%),均为TURP,其中死亡2例;第二阶段经尿道电切手术2 215例,发生TURS者49例(2.21%),无死亡病例。63例均出现不同的TURS症状,出现症状前可伴有血糖升高、低钠血症、中心静脉压升高以及血压波动。术中有24例出现前列腺包膜穿孔(38.1%),经利尿和补充高渗氯化钠溶液等处理后,症状均获改善。结论:TUR中发生TURS与操作技术密切相关,严密观察先兆症状及监测血糖、电解质、中心静脉压等,可较早发现TURS。低压灌注、缩短时间、彻底止血、避免损伤、利尿及纠正低钠血症是防治TURS的有效手段。

Prevention and treatment of transurethral resection syndrome(Report of 2 335 cases)

Objective:To summerize the character and the preventive therapeutic methods of transurethral resection syndrome(TURS) during transurethral resection(TUR).Method:To review the data of 2 335 patients with TUR from 1989 to 2010 and investigate 63 TURS character,relationship with operation technics and therapeutic experiences.Result:The first phase,Among 120 patients,14 with TURP showed TURS(11.67%) and 2 died of TURS.The second phase,Among 2 215 patients,49 showed TURS(2.21%),No patient died in second phase.63 patients showed variant levels TURS symptom.Pre-TURS symptoms included blood glucose increased,serum sodium decreased.CVP(central venous pressure) increased and unstable blood pressure.There were 24 patients had perforation of prostate capsule(38.1%) after using diuria and sodium solution.TURS symptom improved.Conclusion:The occurrence of TURS during TUR was highly related with operation technics,keep close watch over pre-TURS symptoms,blood glucose,serum sodium and CVP,TURS can be detected early.Filling with low pressure,shortening the operation time,keeping haemostasis,avoiding damage,diuresis and correct hyponatremia could effectively prevent and treat TURS.