经尿道前列腺等离子电切术后出血原因及预防

Causes and prevention measures of postoperative bleeding in patients treated with transurethral plasma kinetic resection of prostate

目的分析经尿道前列腺等离子电切术(TUPKP)后出血原因,并制订针对性预防措施。方法回顾性分析该院2015年6月至2016年9月收治的给予TUPKP治疗的349例前列腺增生症(BPH)患者的临床资料,统计349例患者TUPKP后出血发生率,采用SPSS18.0统计软件对影响TUPKP后出血因素进行单因素和多因素分析,并据此制订相关预防措施。结果 349例患者中TUPKP后出血43例,发生率为12.32%。不同年龄、文化程度,是否合并糖尿病、膀胱痉挛、便秘、过度活动、术中止血不彻底、前列腺腺体残留、膀胱过度充盈、泌尿系统感染患者TUPKP后出血发生率比较,差异均有统计学意义(P<0.05);影响TUPKP后出血因素按危险程度由高至低依次为术中止血不彻底、前列腺腺体残留、膀胱痉挛、便秘、膀胱过度充盈、泌尿系统感染、过度活动、糖尿病、年龄大于或等于60岁、专科以下文化程度(优势比分别为8.957、8.435、7.824、7.215、6.584、5.556、4.113、3.541、2.987、2.145)。结论年龄、术中止血不彻底、前列腺腺体残留等均是造成TUPKP后出血的原因,应综合分析患者具体情况,并据此制订针对性预防措施。

Objective To explore the factors of postoperative bleeding after transurethral plasma kinetic resection of prostate（TUPKP） and to make targeted preventive measures. Methods Clinical data of 349 patients with benign prostati c hyperplasia（BPH） received TUPKP treatment in our hospital were analyzed retrospectively,and the incidence of postoperative bleeding was figured. SPSS18.0 software was used to analyze the related factors influencing postoperative bleeding factors by using univariate factor analysis and multivariate logistic regression analysis,and relevant preventive measures were taken according to the result. Results Among 349 cases,postoperative bleeding occurred in 43 cases,with the rate of 12.32%. There were significantly statistical differences in TUPKP postoperative bleeding rate of age,education level,diabetes or not,bladder spasm,constipation,excessive activity,complicated with incomplete intraoperative hemostasis,prostate gland residue,extensive distention of bladder, urinary tract infection（P 0.05）.The factors affecting postoperative bleeding after TUPKP ranging from high danger level to low danger level were incomplete intraoperative hemostasis, prostate gland residue, bladder spasm,constipation,extensive distention of bladder,urinary tract infection,excessive activity,diabetes mellitus,age ≥60 and college degree or below（the odds ratio were 8.957,8.435,7.824,7.215,6.584,5.556,4.113,3.541,2.987 and 2.145,respectively）.Conclusion Age,incomplete intraoperative hemostasis,prostate gland residue,etc. are the causes of postoperative bleeding after TUPKP. The specific situation of patient should be analyzed and targeted preventive measures should be taken to deal with postoperative bleeding after TUPKP.