经尿道前列腺汽化电切术并发症及防治(附124例报告)

Prevention and management of complications of transurethral electrvaporization of prostate:Report of 124 cases

目的探讨经尿道前列腺汽化电切术（transurethral electrovaporization of the prostate，TUVP）并发症的防治。方法1998年6月～2005年8月我们对820例前列腺增生症行TUVP。采用F24 Wolf汽化电切系统，F24 12°电切镜，以精阜为标志切出参照面后，依次分层分段切除前列腺各叶，达至外科包膜，修整膀胱颈部和前列腺尖部组织。结果124例发生并发症，发生率15．1％（124／820）。术中并发症17例（2．0％）：术中大出血6例（0．7％），TURS先兆6例（0．7％），膀胱前列腺交界处穿孔5例（0．6％）；术后并发症107例（13．0％）：尿道狭窄18例（2．2％），膀胱痉挛32例（3．9％），继发出血3例（0．4％），逆行射精11例（1．3％），尿失禁13例（1．6％），尿路感染24例（2．9％），急性肺栓塞6例（0．7％）。结论TUVP术前做好预防工作，术中保持视野清晰，是防止术后并发症发生的重要措施。

Objective To discuss the prevention and management of complications of transurethral electrovaporization of the prostate （TUVP）. Methods A total of 820 patients underwent TUVP from June 1998 to August 2005. A Wolf electrovaporization system and a F24 12° resectoscope were used. After the seminal colliculus was identified for making a reference plane, the prostatic tissues were removed untill the surgical envelope, and the bladder neck and the apex of prostate were surgically shaped. Results Complications occurred in 124 patients （15,1% , 124/820）. There were 17 cases of intraoperative complications （2.0%）, including massive haemorrhage in 6 patients （0.7%）, presymptoms of transurethral resection syndrome in 6 patients （0.7%）, and perforation on the juncture of the bladder and the prostate in 5 patients （0.6%）. There were 107 cases of postoperative complications （13.0%）, including urethral stricture in 18 patients （2.2%）, spasm of the bladder in 32 patients （3.9%）, secondary hemorrhage in 3 patients （0.4%）, retrograde ejaculation in 11 patients （1.3%）, temporary incontinence in 13 patients （1.6%）, infection of the urinary tract in 24 patients （2.9%）, and acute pulmonary thromboembolism in 6 patients （0.7%）. Conclusions Preoperative precautions and clear intraoperative exposure are essential to prevent the incidence of complications of TUVP.