经尿道前列腺切除治疗重度前列腺增生症(附378例报告)

TRANSURETHRAL RESECTION OF PROSTATE FOR THE TREATMENT OF LARGE VOLUME BENIGN PROSTATIC HYPERPLASIA (REPORT OF 378 CASES)

目的 :探讨经尿道前列腺切除 (TURP)治疗重度前列腺增生症 (BPH)的可行性。方法 :采用TURP治疗重度的BPH 378例。前列腺平均重量 73.8g。膀胱灌洗压力 5 0～ 6 0cmH2 O ,平均流量 2 5 0～ 35 0ml/min。术中血电解质监测 ,血钠降低 10mmol/L ,肌注速尿 2 0mg。结果 :平均手术时间 132min。前列腺组织的平均去除率 75 .3%。发生经尿道切除综合征 (TURS) 1例 (0 .2 6 % )。术后排尿通畅率为 10 0 %。 3个月后最大尿流率由术前 (5 .9± 2 .5 )ml/s升至 (2 2 .6± 7.3)ml/s(P <0 .0 1)。术后随访 ,生活质量 (QOL)良好者 95 .6 %。结论 :术中低压、低流量膀胱灌洗 ,监测血电解质变化 ,及时治疗低钠血症 ,增加手术时间 ,TURP治疗重度BPH是安全、可行的。

Objective:To evaluate the reliability of transurethral resection of prostate (TURP) for the treatment of large volume benign prostate hyperplasia (BPH).Methods:We treated 378 cases of large volume BPH with TURP.The mean weight of prostate was 73.8g.The pressure of irrigating fluid was 50～60cmHg and the flux of it was 250～350ml per min.The blood electrolyte was tested in the operation and every patient was injected with 20mg furosemide when reducing the blood sodium by 10mmol/L.Results:The time of TURP was 90～190 minutes with an average time of 132 minites.The mean weight of prostate resected was 55.6g.The average percentage of tissue resected was 75.3%.Only one patient with a TUR syndrome was detected during TURP.All patients got nomal micturation after operation.We followed up on 320 patients for 4～96months.The maximum flow rate increased from 5.9±2.5ml/s to 22.5±7.3ml/s( P <0.001).95.6% patients had the high guality of life.Conclusions:The irrigating of lower pressure and lower flux,blood electrolyte monitoring,treatment for hyponatruria,staunch and unconstraining of operating time during TURP can improve resection ratios of large volume gland.Thus resection with TURP for large volume BPH is safe and reliable.