经尿道前列腺电切术后远期出血的原因及防治探讨

THE REASONS OF TRANSURETHRAL RESECTION OF THE PROSTATE ON LONG TERM POSTOPERATIVE BLEEDING AND PREVENTION

目的探讨经尿道前列腺电切术后远期出血原因、诊疗方法及预防措施。方法回顾我院2000—2011年共发生20例经尿道前列腺电切术后远期出血患者的临床资料,10例予以保留导尿,膀胱冲洗,6例予以电切镜下膀胱冲洗止血治疗,1例膀胱切开血凝块清除术,3例抗感染治疗。19例治愈,1例再次出血,予电切镜止血。结果总结分析远期出血的好发时间为术后1～4周;主要原因是患者自身因素(高血压病、糖尿病、冠心病、脑血管病应用抗凝药物、COPD)及久坐、大便干燥、慢性咳嗽、剧烈活动、坐浴、电切创面焦痂脱落、前列腺电切创面感染等;治疗上对膀胱内充满凝血块不能冲洗吸出者电切镜下清理凝血块及止血是一种安全有效的方法。结论全面的术前分析和采取预防措施、准确的术中和术后处理及详细的出院指导和抗生素应用是预防BPH患者TURP术后远期出血的关键,术后及时发现出血并正确处理可避免再次手术。

Zhang Hongshuang , Duan Zonghao. Department of Urology, Huainan Xin Hua Hospital, Huainan 232052, China Abstract Objective To discuss the causes on long term postoperative bleeding of TURP, methods of diagnosis and treatment and preventive measures. Methods The clinicaI data of 20 cases of TURP on long term postoperative bleeding in author＇s hospital from 2000 to 2011 were analyzed retrospectively. In all of them, 10 cases of retained urethral catheterization, bladder irrigation, 6 cases under the irrigation of bladder reseetoscope hemostatic treatment, 1 cases of bladder blood clot removal by incision, 3 cases of antiinfection treatment. Finally 19 cases were cured, 1 cases of bleeding again and an electricity cut mirror hemosta- sis had to be performed. Results Summary and analysis of long term hemorrhage good time for 1 - 4 weeks after operation; The main reasons included the patients factors （ hypertension, diabetes, coronary heart disease, cerebrovaseular disease using anticoagulant drugs, COPD ） , sedentary, dry stool, chronic cough, strenuous activity, bath, electricity cut wound eschar shedding, transurethral resection of the prostate wound infection and so on. Electricity cut mirror cleaning coagulation and hemostasis would be a safe and effective method if bladder filled with blood clots could not be washed out. Conclusion Comprehensive preoperative analysis and available preventive measures, accurate intraoperative and postoperative treatment and detailed guidance and use of antibiotics are the key of TUR prevention of BPH patients on longterm postoperative bleeding. Postoperative timely detection of bleeding and correct processing can avoid reoperation.