多微孔膀胱穿刺造瘘在大前列腺电切术中的应用

Application of bladder puncture with a suprapubic multi-small-hole trocar in transurethral resection of the large prostate

目的评估多微孔膀胱穿刺造瘘在大前列腺电切术(TURP)中的应用价值。方法 80例行TURP术的大体积良性前列腺增生(BPH)患者,分为多微孔膀胱穿刺造瘘组和非造瘘组,比较两组术中出血量、心率和血压变化、前列腺切除重量、手术时间、并发症及3个月后两组最大尿流率、残余尿量、国际前列腺症状评分等指标的变化,分析两组的手术安全性和效果,评估多微孔膀胱穿刺造瘘的应用价值。结果多微孔穿刺造瘘组和非造瘘组术中出血量、前列腺切除重量、心率和血压变化值、手术前后静脉血钠下降值分别为(166.9±80.0)ml和(211.5±104.7)ml、(46.70±12.91)g和(34.86±9.42)g、(4.6±3.5)次/min和(6.6±4.7)次/min、(5.68±4.01)mmHg和(9.62±7.26)mmHg、(5.4±3.6)mmol/L和(7.3±4.6)mmol/L,组间差异有统计学意义(P<0.05)。多微孔造瘘组低钠血症发生率为34.1%,低于非造瘘组的48.7%,特大体积前列腺的比例(26.8%)高于非造瘘组(7.6%)。结论多微孔膀胱穿刺造瘘低压灌注,更能保持冲洗液引流通畅和手术视野清晰,增加大体积前列腺的手术安全性,在大体积TURP术中仍有较高的应用价值。

Objective To evaluate the value of bladder puncture with a suprapubic multi-small-hole trocar in the transurethral resection of prostate （TURP）. Methods A total of 80 patients of benign prostatic hyperplasia （BPH） with large volume were divided into the study group （n=41） and the control group （n=39）. Patients in the study group underwent TURP with a suprapubic multi-small-hole trocar, while patients in the control group were not treated with bladder puncture. The intraoperative blood loss, weight of the resected prostate, changes in heart rate, changes in blood pressure, decrease of serum sodium, operative time, and post-operative complications were compared between the two groups to assess the safety of treatment. The maximum urinary flow rate （Qmax）, postvoid residual urine volume （PVR）, international prostate symptom score （IPSS） were compared three months post-operation to evaluate the efficacy of treatment. Results The blood loss, weight of resected prostate, changes in heart rate, changes in blood pressure, decrease of serum sodium in the study group and the control group were （166.9±80.0） ml vs （211.5±104.7） ml, （46.70±12.91） g vs （34.86±9.42） g, （4.6±3.5） times/min vs （6.6±4.7） times/min, （5.68±4.01） mmHg vs （9.62±7.26） mmHg,（5.4±3.6） mmol/L vs （7.3±4.6） mmol/L, respectively. Statistically significant differences were found between the two groups （P0.05）. The incidence of hyponatremia in the study group was lower than that in the control group, 34.1% （14/41） vs 48.7% （19/39）. The operative proportion of large volume prostate in the study group was 26.8%, which is higher than 7.6% in the control group. Conclusion Bladder puncture with a suprapubic multi-small-hole trocar and low hydraulic pressure irrigation in TURP proves to have less hyponatremia and post-operative complications, with higher operative safety and value, especially for patients with large prostate.