经尿道前列腺切除术后再手术原因分析

Analysis of causes of reoperation after transurethral resection of prostate

目的探讨经尿道前列腺切除术后再手术的原因。方法回顾分析202例经尿道前列腺切除术的临床资料,其中再手术16例中,继发出血7例、尿道狭窄6例和前列腺癌3例,分析原因及处理对策。结果术后出血可能有腺体残留、切面不光整、前列腺创面感染、膀胱痉挛、电凝创造面焦痂脱落等引起。尿道狭窄和膀胱颈挛缩可能与术中切断膀胱颈口环形肌肉、电凝时功率过大、气囊管牵拉过度或时间过长有关。导尿管过粗,留置时间过长,拉力过大,对尿道产生压迫作用,引起尿道黏膜缺血坏死致尿道狭窄。术前常规行血清PSA检查,排除前列腺癌,术后应即行薄层病理切片检查,以尽早发现隐藏的前列腺癌。16例再手术与腺体残留、感染、膀胱颈部挛缩和导尿管压迫留置时间过长等因素有关,再次手术治愈。结论围手术期处理和熟练掌握手术操作技术是防止经尿道前列腺切除术后再手术的关键。

Objective To analyze the causes of reoperation after transurethral resection of prostate. Methods Clinical data of 202 patients who underwent transurethral resection of prostate were retrospectively analyzed, For all of -them,16 cases received reoperation including seven cases of secondary hemorrhage, 6 cases of urethral stricture and three cases of prostate cancer. The causes and treatment measures were summarized and evaluated. Results Post-operative bleeding may result from residual gland, irregular cutting-plane, prostate wound infection, bladder spasm, eschar shedding from the electric coagulation-created surface and so on. Urethral stricture and bladder neck contracture may be related to cutting off circular muscles at the opening of the urinary bladder during surgery, excessive power during electrocoagulation, and excessive or prolonged traction to the balloon tube. Too thick catheter, too long retention time,and too much tension lead to repression effect on the urethra, causing urethral mucosa ischemic necrosis, resulting in urethral stricture, all reoperated patients were cured. Conclusion Perioperative management and surgical skills were key points for preventing reoperation after transurethral resection of prostate.