经尿道前列腺切除(TURP)术后大出血的原因和处理

Prevention and Management of Severe TURP Hemorrhage

目的 :探讨经尿道前列腺切除 (TURP)术后大出血的原因和防治对策。方法 :对本院 2 0 0 1年 9月～ 2 0 0 4年 1月行TURP术的 2 15例患者临床资料进行回顾性分析。结果 :2 15例患者中 ,12例术后大出血 ,其中术后早期出血 4例 ,迟发性出血 8例。9例经保守治疗治愈 ,2例经再次开放手术止血 ,1例经电切镜止血。结论 :术中止血确切及术后保证引流通畅是预防TURP术后大出血的关键 ;术后及时发现出血并正确处理可避免再次手术之苦 ;对膀胱内已充满血块不能吸出者需再次手术 ;

Objective: To investigate the causes and the management of severe TURP bleeding. Methods: Data of open prostatectomies for patients with benign prostatic hyperplasia(BPH) was reviewed retrospectively. Results: A series of 215 consecutive men with benign prostatic hyperplasia received open prostatectomy between Sep. 2001 and Jan.2004 in our hospital,of which 12 had severe post-prostatectomy hemorrhage. Early bleeding occurred in 4 patients and late bleeding in 8. Among these patients, 9 underwent conservative treatment, 2 needed reexploration to achieve hemostasis,and the rest 1 received endoscopic cautery techniques. Conclusion:Definite intraoperative hemostasis and postoperation care focused on monitoring the patient for catheter patency can effectively prevent TURP hemorrhage. Managed properly, most patients could stop bleeding without reexploration. Reexploration is generally reserved for severe refractory cases involving ongoing hemorrhage and clot retention. Endoscopic cautery technique offers a safe and an efficient method of delivering hemostasis.