耻骨上膀胱穿刺引流在经尿道前列腺电切术中的应用

Application of Suprapubic Needle Aspiration of Bladder in Transurethral Resection of the Prostate

目的探讨前列腺体积>60 mL的前列腺增生症患者的手术安全性,提高部分合并尿道狭窄前列腺增生症患者的手术实施率。方法 2009年3月-2010年3月,行耻骨上膀胱穿刺引流下经尿道前列腺电切术(TURP)治疗前列腺增生58例。年龄54～93岁,平均72岁,病程8个月～12年,平均7.2年;前列腺体积35～128 mL,平均78 mL;国际前列腺症状评分24～35分,平均30.2分;最大尿流率1.2～4.8 mL/s,平均1.8 mL/s;残余尿量84～210 mL,平均160 mL。术前无尿潴留28例。结果 58例顺利完成手术,其中2例伴包膜穿孔,9例前尿道狭窄者通过去外鞘电切镜完成手术。所有患者切除前列腺组织体积18～86 mL,平均58 mL;术中冲洗液为5%葡萄糖液,用量18 600～42 500 mL,平均23 500 mL;手术时间45～185 min,平均70 min。术后病理检查均示良性前列腺增生,术后住院时间3～8 d,平均5 d。术后患者最大尿流率为18～46 mL/s,平均32 mL/s。结论耻骨上膀胱穿刺引流能降低膀胱内压,减少水、糖分吸收,增加手术安全性,提高了部分合并前尿道狭窄的前列腺增生患者的手术几率。

Objective To promote the safety of operation on benign prostatic hyperplasia （BPH） patients with a prostate volume larger than 60 mL, and to increase surgery probability for patients with both BPH and anterior urethral stricture, Methods From March 2009 to March 2010, suprapubic needle aspiration of bladder and transurethral resection of the prostate （TURP） were performed on 58 patients with BPH. The age of the patients ranged from 54 to 93 years old averaging at 72. The disease course ranged from 8 months to 12 years with an average of 7.2 years. Prostate volume ranged from 35 to 128 mL averaging 78 mL. International prostate symptoms score （I-PSS score） ranged from 24 to 35 points with an average of 30.2± 2.4 points. The biggest urine flow rate ranged from 1.2 to 4.8 mL/s averaging （1.8± 0.2） mL/s. Residual urine volume ranged from 84 to 210 mL, averaging at 160 mL. Twenty-eight patients had no urinary retention before operation. Results Fifty-six patients successfully completed the operation. Nine patients with anterior urethral stricture also underwent the operation successfully with resectoscope outer sheath cutting. The volume of removed prostate tissue ranged from 18 to 86 ml with an average of 58 mL. Intraoperative rinse was 5% glucose solution （GS） and its dose ranged from 18 600 to 42 500 mL averaging 23 500 mL. Operation time ranged from 45 to 185 minutes with an average of 70 minutes. Postoperative pathological examination showed that all of them were benign hyperplasia. Postoperative hospital stay time was from 3 to 8 days, averaging 5 days. After operation, the biggest urine flow rate ranged from 18 to 46 mL/s, averaging 32 mL/s. Conclusion Suprapubic bladder puncture and drainage can reduce the stress inside the bladder, lower water and sugar absorption, increase the safety of operation, and enhance surgery probability for patients with BPH and