经尿道前列腺切除术后并发症14例分析

Complications following transurethral prostatectomy: An analysis of 14 cases

目的探讨经尿道前列腺切除术后常见并发症的原因、预防和处理方法。方法2002年8月～2005年8月。我院经尿道前列腺电切术、经尿道前列腺电汽化术治疗良性前列腺增生症73例，出现14例并发症，包括术中严重出血2例，术后尿潴留5例，尿道狭窄2例，尿失禁2例，包膜穿孔致电切综合征2例，下肢深静脉血栓1例。结果1例严重出血者中转开放手术，无再次出血；1例经放置三腔单囊尿管，持续盐水或冰盐水膀胱冲洗，配合止血药物治疗，也未再次发生出血，术后排尿顺畅。5例术后尿潴留，其中2例再次经尿道前列腺电切手术，3例经尿道扩张术结合口服对症药物，5例均无再次尿潴留，术后1—3个月复查，尿流率〉15ml／s。2例尿道外口狭窄者定期尿道扩张1个月，排尿顺畅。2例尿失禁行永久膀胱造瘘术。2例包膜穿孔致电切综合征经迅速结束手术，积极对症治疗，生命体征平稳，术后排尿顺畅。1例下肢深静脉血栓2周后治愈。结论尿潴留、尿道狭窄是经尿道前列腺切除术后常见并发症，严格掌握手术指征，熟练细致地操作，及时有效地处理可以避免出现严重后果。

Objective To study the etiology, prophylaxis, and management of complications after transurethral prostatectomy. Methods Clinical data of 73 patients with benigh prostatic hyperplasia （ BPH ） undergoing transurethral resection of prostate （TURP） or transurethral vaporization of prostate （TUVP） in this hospital from August 2002 to August 2005 were reviewed. Complications occurred in 14 patients, including severe bleeding in bladder in 2 patients, postoperative urinary retention in 5 patients, urethral stricture in 2 patients, urinary incontinence in 2 patients, TURP syndrome due to the perforation of the prostatic membrane in 2 patients, and lower- extremity deep venous thrombosis in 1 patient. Results A conversion to open surgery was required in 1 patient with severe bleeding in bladder and no re -bleeding happened. In another patient with severe bleeding in bladder, a trilumen single balloon catheter was intriduced into the bladder for continuous bladder irrigation with normal saline or iced normal saline, in association with medical therapy, to obtain a full recovery of voiding function without re - bleeding. Among 5 patients with urinary retention after operation, a re - operation of TURP was conducted in 2 patients and a dilatation of the urethra in association with oral symptomatic medication was carried out in 3 patient. No recurrence of urinary retention was noted and a re - examination of the maximum flow values （Qmax） at 1 - 3 months after operation revealed more than 15 ml/s. The voiding function recovered well in 2 patients with urethral stricture after periodic dilatation of the urethra. Permanent cystostomy was performed in 2 patients with urinary incontinence. In 2 patients with TURP syndrome, the operation was terminated immediately and active symptomatic treatment was conducted. The two patients experienced stable vital signs and a good recovery of voiding function. The patient with lower - extremity deep venous thrombosis was cured 2 weeks later. Conclusions Urinary retention and urethral stricture are common complications following transurethral resection of prostate. Careful selection of patients, strict adherence to technique, and timely and proper management of complications are considered essential to improve results.