Madigan术式适应证选择中的有关问题

QUASTIONS RELATING TO THE INDICATIONS OF THE MADIGAN PROSTATECTOMY

总结Madigan前列腺切除术71例中一组特殊病例共11例，均涉及到手术适应证选择中的有关问题，包括口服乙烯雌酚致腺体纤维化3例，前列偶发癌3例，中叶突出后致膀胱颈后唇粘膜肌层肥厚致梗阻2例，膀胱逼尿肌功能失代偿3例，均引起了手术困难或手术恢复不良。结合文献复习，就Madigan手术的适应症进行了讨论。提出应注意药物对腺体组织结构的影响。若术中分离腺体困难，应注意增生与癌并存的问题，是否进一步治疗随访，应视腺体癌的细胞分化及癌灶体积的大小。手术时腺体中叶增生明显，应充分估计到膀胱颈口的粘膜肌层继发性病变。对长期下尿路使四致膀胱逼尿肌功能严重受损者，应重视逼尿肌功能恢复的可逆性。为对BPH的治疗时机、方式、疗效有合理的评价，尿流动力学检查应成为BPH手术适应证选择的重要参数。

11 particular cases undergone the Madigan prostatectomy for symptomatic BPH were reported because of their difficult situation within operations and poor results after operations, including BPH with estrogen users, incidental carcinoma of the prostate, bladder neck muco - myofibrostic hypertrophy and detrusor decompensation.With the review of literature, the quastions relating to the indications of the Madigan prostatectomy were discused. Some suggestions were put farword and urodynamics was emphysed for preoperative evaluations in BPH patients.