经尿道电汽化前列腺切除术电切综合征27例

Transurethral resection syndrome during transurethral vaporization of the prostate: Report of 27 cases

目的探讨经尿道电汽化前列腺切除术(transurethralvaporizationoftheprostate,TUVP)发生经尿道电切综合征(transurethralresectionsyndrome,TURS)的原因及诊治经验。方法回顾性分析我院2002年9月～2005年3月322例TUVP发生27例TURS的临床资料。结果27例平均手术时间95min(52～170min),平均出血量251ml(100～700ml),切除前列腺组织16～82g,平均36.1g。21例前列腺被膜切破(77.8%)。27例术后均有打呵欠,血压下降,同时伴有心率过缓,27例TURS时血清Na+(122.3±9.6)mmol/L,较术前下降(16.3±4.5)mmol/L,差异有显著性(t=14.211,P<0.001)。经及时10%氯化钠溶液、血管活性药、利尿等治疗后,26例迅速恢复正常;1例前列腺创面渗血合并膀胱血块填塞,开放手术治愈。27例随访1～3个月,Qmax(20.2±5.2)ml/s,无尿失禁。结论前列腺被膜穿孔、静脉窦(丛)被切破、高压冲洗下电切、手术时间过长(超过90min),促使TURS的发生;认识TURS的早期症状,及时采取治疗措施,可使病人转危为安。

Objective To summarize the causes, diagnosis and treatment of transurethral resection syndrome (TURS) during the transurethral vaporization of the prostate (TUVP). Methods Among 322 consecutive patients who underwent TUVP, TURS happened in 27 patients (8.4%). Their clinical data on the operation, monitoring and treatment were retrospectively reviewed. Results Of the 27 patients, the mean operative time was 95 min (52~170 min), the mean blood loss was 251 ml (100~700 ml), and the mean weight of resected prostate was 36.1 g (16~82 g). During the operation the prostatic capsule was perforated in 21 patients (78%). Postoperatively, all the patients had yawning, hypotension and bradycardia. Their serum sodium concentrations during TURS were 122.3±9.6 mmol/L, which was 16.3±4.5 mmol/L lower than before the operation, with significant difference ( t=)14.211,P<0.001). TURS resulted in rapid recovery in 26 patients after a prompt administration of intravenous 10% saline, vasoconstrictive drugs and diuretics. One patient was cured by open surgery because the prostatic wound kept oozing with blood and the bladder was filled up with blood clots. No death occurred. Follow-up for 1~3 months showed a Qmax value of 20.2±5.2 ml/s and no urinary incontinence. Conclusions Precipitating factors of TURS include the perforation of the prostatic capsule, the venous sinus injury, the high pressure irrigation, and the prolonged operation time (>90 min). Close attention and assessment of the patient’s) vital signs and mental status can increase the early detection and treatment of TURS.