蛇毒血凝酶膀胱冲洗及灌注对前列腺电切术后止血的疗效

Hemostatic effect of hemocoagulase used in bladder irrigation and intravesical instillation after transurethral resection of the prostate

目的探讨蛇毒血凝酶膀胱冲洗及灌注在经尿道前列腺电切术(TURP)后的止血效果。方法 2010年3月～2012年3月经筛选后69例接受TURP术患者随机分为3组,所有患者术后均行常规生理盐水持续膀胱冲洗。其中膀胱灌注组20例,蛇毒血凝酶6 U加入生理盐水60 mL术后膀胱保留灌注20 min,2次/d,共3 d;膀胱冲洗组23例,蛇毒血凝酶10 U加入生理盐水100 mL膀胱冲洗,2次/d,共3 d;其余26例患者为对照组,仅行生理盐水持续膀胱冲洗。记录3组患者术后前3天出血量并进行统计分析,观察凝血功能及不良反应。结果 3组间患者年龄、前列腺体积、手术时间差异均无统计学意义,且各组患者无明显凝血功能改变及并发症发生。膀胱灌注组、膀胱冲洗组术后3 d总出血量与对照组比较明显减少(P<0.05);膀胱灌注组与冲洗组之间术后前3 d总出血量和每天出血量之间无明显差异。结论蛇毒血凝酶局部用药能有效减少TURP术后出血,安全性好。

Objective To evaluate the hemostatic effect of hemocoagulase used in bladder irrigation and intravesical instillation after transurethral resection of the prostate （TURP）. Methods From March 2010 to March 2012, 69 selected patients who underwent TURP were randomly divided into three groups, and all patients were administrated with postop- erative continuous bladder irrigation using NS conventionally. 20 cases in the intravesical instillation group were given postoperative intravesical instillation using 6 U hemocoagulase in 60 mL NS for 20 min, bid for 3 d. 23 cases in the bladder irrigation group were given bladder irrigation using 10 U hemocoagulase in 100 mLNS, bid for 3 d. The rest of 26 patients were assigned to the control group with continuous bladder irrigation using normal saline （NS）. The bleed- ing volumes in the 3 days after surgery of the 3 groups were recorded and analyzed by using SPSS16.0 software and the coagulation function and adverse effects were observed. Results There was no significant difference of patients＇ age, prostate volume or operation time among the three groups, additionally, no obvious coagulant function change and com- plications occurred in the patients of the three groups. Compared with that of the control group, the total bleeding vol- umes of the postoperative 3 days in the experimental groups of hemocoagulase were significantly reduced （ P 〈 0.05 ）. However, for 3 days＇ total or each day＇s blood bleeding volume, no significant difference was observed between the bladder irrigation group and the intravesical instillation group. Conclusion Local application of hemocoagulase was effective and safe in reducing postoperative bleeding after TURP.