比较围手术期应用度他雄胺和非那雄胺对经尿道前列腺电切术出血量的影响

Effect of perioperative use of dutasteride and finasteride on bleeding volume in transurethral prostatectomy

目的比较围手术期应用度他雄胺和非那雄胺对经尿道前列腺电切术出血量的影响,为临床提供指导意义。方法将确诊的90例前列腺增生患者随机分成度他雄安组、非那雄胺组、对照组3组。度他雄安组、非那雄胺组术前及术后均口服药物1周,剂量为安福达0.5mg/次;非那雄胺组术前及术后均口服非那雄胺1周,5mg/次;对照组术前术后未给予任何药物,患者均经同一手术组医师使用等离子电切系统进行手术。对3组患者术中出血量、手术时间、术后膀胱冲洗液的量等进行比较。结果所有患者均顺利完成手术,效果满意,围手术期间均未发现药物副作用。3组患者术前、术后血红蛋白差值分别为(-1.29±0.81、-1.25±0.68、-1.83±1.25)g/L;血细胞压积差值分别为(-5.67±2.58、-6.34±2.89、-6.50±2.40)L/L;3组手术时间两者分别为(58.4±19.5、57.62±21.33、55.62±23.76)min;术后膀胱冲洗液量分别为(18.33±2.35、19.25±3.20、25.35±1.98)L,均有统计学差异(P<0.05)。度他雄安组术后膀胱冲洗液量少于非那雄胺组(P<0.05),但在手术出血量、手术时间两者比较无明显差异(P>0.05)。结论围手术期应采用非那雄胺或度他雄胺均可减少前列腺增生患者术中及术后出血量,缩短手术时间、减少术后膀胱冲洗液量,是有效、安全的,值得临床推广应用。

Objective To compare the effect of perioperative use of dutasteride and finasteride on the bleeding volume in transurethral prostatectomy.Methods A total of 90 confirmed benign prostate hyperplasia（BPH）cases were randomly divided into dutasteride group,finasteride group and control group.Patients in dutasteride group and finasteride group took dutasteride or finasteride 0.5 mg orally once a day for 1 week before operation and1 week after operation.Patients in the control group did not take any drug.All patients underwent transurethral plasmakinetic prostatectomy（TUPKP）by the same surgical team using the Gyrus F27 resectoscope.Intraoperative blood loss,operation time and lavage fluid volume were compared between the three groups.Results All operations were successful,and none patients treated with dutasteride and finasteride reported any side effects.The preoperative and postoperative hemoglobin of the dutasteride group,finasteride group and control group was（-1.29±0.81,-1.25±0.68,-1.83±1.25）g/L,the haematocrit was（-5.67±2.58、-6.34±2.89、-6.50±2.40）L/L,the operation time was（58.4±19.5,57.62±21.33,55.62±23.76）min,postoperative bladder lavage fluid volume was（18.33±2.35,19.25±3.20,25.35±1.98）mL.There were statistically significant differences（all P〈0.05）.The postoperative bladder lavage fluid volume of the dutasteride was less than that of the finasteride group（P〈0.05）,but there was no difference in blood loss and operation time（P〈0.05）.Conclusion Both finasteride and dutasteride can reduce intraoperative and postoperative blood loss in patients with prostatic hyperplasia,shorten the operation time,and reduce the lavage fluid volume.They are worthy of clinical application.