良性前列腺增生再次经尿道前列腺切除术116例临床分析

Clinical study on reoperation of transurethral resection of the prostate(report of 116 cases)

目的分析良性前列腺增生(BPH)再次经尿道前列腺切除术(TURP)的原因,并总结临床诊治体会。方法1990年12月-2006年5月,我院收治因BPH行TURP术患者116例。对本组二次住院TURP治疗的临床资料及二次出院后的随诊资料进行回顾分析。结果116例中,初次手术时因高龄高危而选择姑息通道手术者71例(61.2%),前列腺体积大于60mL者83例(71.5%),术中切穿包膜或静脉窦而中止手术者5例(0.4%)。再入院原因,单纯排尿困难46例(39.7%),反复血尿10例(8.6%),排尿困难合并血尿52例(44.8%),排尿困难和(或)血尿同时合并下尿路感染8例(6.9%)。二次入院后经B超及电切镜检查,皆证实有前列腺组织残留或同时合并腺体再增生,再次行TURP治疗。切除残留腺体、再增生腺体。再次手术出院后随访108例,疗效满意94例(87.0%)。结论BPH再次TURP主要由于高龄高危患者、前列腺体积较大、组织残留较多或再增生以及在此病理基础上的继发出血、下尿路感染。再次TURP手术疗效良好。

Objective To analyse the reason of reoperation of transurethal resection of the prostate and improve the level of prognosis and treatment of benign prostatic hyperplasia （BPH）. Methods In this retrospective study, from 1990 to 2005, 116 cases of benign prostatic hyperplasia after TURP were selected by comparing the first operation data with the reoperation one. Results Of the 116,cases of recurrent BPH, 71cases （61.2%） at high risk were incompletely ablated at first. 83 cases （71.5%） of prostate specimen weighed more than 60 mL. 5 cases were incompleted because of perforation of the prostate capsule. In the recurrence cases, 46 （39.7%） were impotent, 10 （8.6%） had recurrent hemorrhage, and 52 had both symptoms. Impotence and recurrence combined with chronic prostatitis accounted for 8 （6.9%）. All patients were diagnosed by the BUS and cystoscopy and then underwent TURP again. The major reasons of the recurrence after operation were incomplete resection of prostate in the TURP, the gland cell proliferation and prostatitis. 94 cases （87.0%） obtained satisfactory results in the 108 cases followed. Conclusion In patients at high risk, lager volume of prostate, tissue residue and gland cell proliferation with secondary hemorrhage and chronic prostatitis were the vital factors related to recurrence after TURP. Performing TURP again maybe a good choice.