经尿道等离子前列腺切除术中膀胱爆炸3例分析

Analysis of 3 cases of bladder explosion in transurethral plasma prostatectomy

目的:探讨经尿道等离子前列腺切除术(TUPKRP)中膀胱内气体爆炸的原因,采取相应措施,以减少膀胱爆炸的发生。方法:回顾分析TUPKRP导致膀胱破裂2例和1例膀胱肌层裂伤的诊断、治疗过程,结合文献分析膀胱爆炸的原因。结果:2例膀胱破裂患者经开放手术治愈,1例膀胱肌层裂伤患者经保守治疗而愈。膀胱爆炸主要原因是电切前列腺组织时产生的可燃性气体与外界进入膀胱内气体混合达到一定比例,在电切火花作用下,引起爆炸。结论:采用头高臀低位,尽可能缩短手术时间,减少气体进入膀胱,在前列腺窝顶部气体中电切或电凝前及时排出膀胱内气体是预防膀胱爆炸的重要预防措施。

ObjectiveTo investigate the causes of bladder explosion during transurethral plasmakinetic resection of prostate and to explore effective measures to reduce the risk of bladder explosion.Methods The treatment process of bladder rupture(2 cases)and bladder muscle layer laceration(1 case)during transurethral plasmakinetic resection of prostate were retrospectively analyzed.Results Two cases with intra-peritoneal rupture were cured by open surgery,and 1 case with bladder muscle layer laceration was cured by conservative treatment.The main cause of bladder explosion is that the flammable gas produced during the resection of prostate tissue mixed with the gas from the outside into the bladder to a certain proportion,in the action of electric spark,causing gas explosion.Conclusions Using dorsal elevated position,shortening operative time,and reducing gas entering the bladder are three key points to prevent bladder explosion.