低压虹吸系统在经尿道前列腺电切术中的应用

Applications of syphon system in transurethal resection of prostate

目的探索利用自制膀胱测压预警系统实施低压经尿道前列腺电切术(TURP)的可行性与安全性。方法 2014年1月-2016年1月167例行前列腺电切的前列腺增生(BPH)患者按随机数字表法分为测压组(A组)和非测压组(B组)。A组85例,采用经皮膀胱造瘘+TURP术式42例(A1组),连续冲洗鞘式TURP术式43例(A2组)。B组82例,采用经皮膀胱造瘘+TURP术式42例(B1组),连续冲洗鞘式TURP术式40例(B2组)。A组利用自制虹吸管经膀胱穿刺形成膀胱测压预警系统进行膀胱测压,实时监测膀胱压力,保持膀胱低压状态进行TURP手术。4组均检测术前、术后血Na^+,记录术中手术时间、术中出血量、切除前列腺质量、尿色转清时间,评估手术前后的国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、残余尿量(PVR)和生活质量评分(QOL)。结果 A组血Na^+术前术后差异无统计学意义,B组血Na^+术前术后差异有统计学意义,提示测压组较非测压组更安全。测压组A1与非测压组B1、测压组A2与非测压组B2相比可用于切除前列腺组织的安全手术时间更长、前列腺切除质量更多,术后尿色转清时间更短,Qmax、IPSS改善更佳,提示测压组较非测压组治疗效果更佳。结论自制膀胱测压预警系统可以及时发现TURP术中膀胱内高压状态,可以及时处理造成高压的原因,始终能保持低压冲洗下进行TURP,延长了安全手术时间,增加组织切除率,明显降低电切综合征的发生,使TURP更具安全性。

To explore the availability and safety of conducting low-pressure TURP assisted by ahome-made cystometry and warning system.Methods167benign prostatic hyperplasia(BPH)patients admittedfrom Jan2014to Jan2016were randomly assigned into cystostomy group(group A)and non-cystostomy group(group B).In group A(n=85),42patients(group A1)were performed percutaneous cystostomy+TURP,and43(group A2)were performed continuous flushing sheath TURP.In group B(n=82),42patients(group B1)werereceived percutaneous cystostomy+TURP,and40(group B2)were received continuous flushing sheath TURP.Ingroup A,bladder pressure was monitored in real time with a cystometry and was monitored by bladder puncture usinga home-made siphon,ensuring low bladder pressure throughout TURP.Serum Na+levels were measured before and after operation in all four groups.The operation time,the intraoperative bleeding,the weight of resected prostatesand the time before which urine turned clear were recorded.The IPSS,maximum flow rate(Qmax),postvoid residualvolume(PVR)and life quality score(QOL)were evaluated.Results While no significant differences were foundbetween group A1and A2,there were significant differences between group B1and B2,indicating cystostomygroup was safer than non-cystostomy group.When compared group A1with B1,or group A2with B2,it showedthat the safe operation time to perform prostate tissue resection was longer in cystostomy group;the weight of theresected prostates was heavier;the time before which urine turned clear were shorter;and the IPSS improvementwas better.These findings presented better therapeutic effects in cystostomy group than in non-cystostomygroup.Conclusions This home-made cystometry and warning system could timely detect high bladder pressurestate during TURP,making it possible to avoid of high pressure,ensuring low bladder pressure flushing during theoperation,lengthening the safe operation time,increasing tissue resection ratio,reducing transurethral resectionsyndrome,thus helping TURP to be safer.