Peel-away鞘在经尿道等离子前列腺电切术膀胱穿刺引流中的应用(附26例报告)

Application of suprapubic peel-away sheath aspiration of bladder to transurethral bipolar plasmakinetic resection of the prostate(report of 26 cases)

目的提高经尿道前列腺等离子电切术(PKRP术)治疗高危前列腺增生症的安全性及疗效,减少并发症的发生。方法对26例高危前列腺增生患者经尿道置入等离子电切镜,灌入生理盐水300～500ml充盈膀胱,于耻骨上两横指腹正中线上取长约0.5cm小切口,切开皮肤、皮下层至腹直肌前鞘,用经皮肾镜16FPeel-away鞘行膀胱穿刺引流,使膀胱处于低压状态,开始进行PKRP术,术后从尿道插入F20～22号三腔气囊尿管,气囊注水30ml,牵引导尿管尾端,在适当张力下用宽纱布条缠绕导尿管紧贴尿道外口捆扎,观察引流通畅后拔除耻骨上Peel-away鞘,缝合膀胱穿刺切口。结果该组26例患者手术均安全顺利完成,未出现TUR综合征、大出血、膀胱穿孔等并发症,无死亡病例,轻度尿失禁者3例,1～2个月恢复尿控。结论经尿道前列腺等离子切除术结合耻骨上Peel-away鞘膀胱穿刺引流,安全性高、疗效确切,减少了并发症的发生。

Objective To improve the safety and efficacy of transurethral plasmakinetic resection of prostate in treating symptomatic benign prostatic hyperplasia patients at high risk,and decrease the complication rate of surgery.Methods 26 cases with benign prostatic hyperplasia at high risk were put transurethral resectoscope into the bladder,poured into 300~500 ml physiological saline water filling the bladder,where in the two finger breadth of suprapubic midline to cut open about 0.5 cm,by the skin,subcutaneous layers to the rectus abdominis front,we used percutaneous nephrolithotomy 16F Peel-away sheath to cystostomy drainage,so that the bladder low pressure to begin PKRP operation.Postoperation with the F20 ~ 22 Tri-chamber balloon catheter from the urethra into bladder,effusion 30 ml water in the balloon,at the appropriate tension pulling the catheter end,wound with suitable breadth gauze tied closely the catheter.When the draining was easy and smooth,removal of the suprapubic Peel-away sheath was performed.Results All the 26 patients operations were completed safely and smoothly,and there was no TUR syndrome,secondary big hemorrhage,bladder perforation and other complications cases,and no mortality.3 cases had mild urinary incontinence,and restored urinary control in 1 to 2 months.Conclusion Suprapubic Peel-away sheath aspiration of bladder is safe and effective to perform transurethral bipolar plasmakinetic resection of the prostate,with reducing the incidence of complications.