预置可拆除膀胱颈荷包缝合在前列腺增生术后难治性出血的应用

Application of Preset Removable Pouch Suture in Treating of Post-prostatectomy with Intractable Massive Hemorrhage

目的探讨前列腺增生围术期大出血的治疗,探寻前列腺术后难治性出血的有效治疗方法。方法对我院2000年1月至2010年12月因前列腺增生术后难治性大出血而行预置可拆除膀胱颈荷包缝合法止血的28例患者进行回顾性分析。结果 28例患者均止血成功,术后24小时松解荷包缝线以及前列腺窝内气囊,术后48小时术后拆除荷包缝线。所有患者随访3月～5年,术后均排尿通畅,最大尿流率10～15ml/s;其中1例出现尿失禁,经提肛训练后4周后恢复;2例继发附睾炎,经抗感染治疗后治愈;1例6月后出现膀胱颈挛缩经定期扩张尿道后治愈。结论预置可拆除膀胱颈荷包缝合法止血效果确切、并发症少、操作简单、适应证广、容易掌握,是对前列腺增生术后难治性大出血确实有效的手术方法。

Objective To investigate the treatment of hematorrhea in perioperative period of benign prostate hyperplasia （BPH）, explore the effective methods for post-prostatectomy with intractable massive hemorrhage. Methods 28 patients with preset removable pouch suture for post-prostatectomy after intractable massive hemorrhage in our hospital from January 2001 to December 2010 were analyzed retrospectively. Results Hemostasis was achieved successfully in all of 28 cases, with debonding the suture and intra-prostate fossa balloon 24 hours post-operation, removing the suture 48 hours post-operation. All patients were followed up for 3 months to 5 years after operation. All cases had unobstructed urination with the maximum urinary flow rate of 10 ~ 15 ml/s; 1 case had urinary incontinence and recovered 4 weeks after levator ani muscles training; 2 cases had secondary epididymitis and cured with anti-infection treatment; 1 case occurred bladder. Conclusion Preset removable pouch suture treatment is an effective surgical method for patients with post-prostatectomy with intractable massive hemorrhage with definite effect, fewer complications, simple operation, extensive indications and relatively easy to grasp.