经尿道前列腺气化切除术后大出血的再手术治疗

Reoperation of massive hemorrhage following transurethral electrovaporization of prostate

目的总结经尿道前列腺气化切除术(TUVP)后大出血的再手术治疗经验。方法回顾性分析2004年1月—2013年6月TUVP术后大出血非手术治疗无效,经再次电切镜下或开放手术治疗的20例患者的临床资料。结果再手术20例中,电切镜下止血17例,术中发现前列腺窝内创面动脉出血10例,静脉出血5例,后尿道渗血1例,未见明显出血点1例。膀胱内探查手术止血3例,术中发现膀胱颈口前列腺窝边缘动脉出血2例,前列腺窝内渗血1例。术后均成功止血,无休克等严重并发症发生。结论前列腺电切术后大出血原因多为止血不彻底所致,非手术治疗无效的大出血应及时在电切镜下止血处理,安全有效,必要时可考虑膀胱内探查,效果确切。

Objective To summarize the experience of reoperation in the treatment of massive hemorrhage after transurethral electrovaporization of the prostate （TUVP）. Methods We reviewed the clinical data of the patients with massive hemorrhage requiring endoscopic intervention or open surgery after TUVP and not responding to conservative treatment from January 2004 to June 2013. Results Of the 20 patients included, 17 required endoscopic intervention for postoperative bleeding, i.e. arterial hemorrhage in prostatic cavity in 10, venous sinus bleeding prostatic cavity in 5, posterior urethrostaxis in 1 and bleeding without obvious hemor- rhagic spot in I patient（s）. Of the 3 patients required open exploration, 2 had arterial hemorrhage at bladder neck orifice and 1 had bleeding in prostatic cavity. Hemorrhage was controlled after re-surgery in all the cases without significant complications such as shock. Conclusion The reason of significant bleeding after TUVP is mostly attributed to incomplete homeostasis during operation. Persistent bleeding after sufficient conservative therapy should be treated promptly by endoscopic intervention, and if it is not successful, open exploration may be required. Both of the treatments are effective and safe.