置入DJ管在巨大前列腺剜除术中对输尿管口的保护应用

Application value of DJ-catheter indwelling in the protection of ureteral orifice during giant prostate enucleation

目的:探讨DJ管置入在经尿道巨大前列腺剜除术中的操作方法和应用价值。方法:选取64例巨大前列腺增生病人,随机分为置管组和无置管组,各32例。观察组采取DJ管置入应用于巨大前列腺剜除联合粉碎器中,对照组采取巨大前列腺剜除联合粉碎器,比较2组手术时间、切除腺体质量、膀胱冲洗时间、尿管留置时间、术后住院时间和术后血红蛋白(Hb)下降值及术后6个月国际前列腺症状评分(IPSS)、生活质量指数评分(QOL)、最大尿流率(Qmax)、残余尿(PVR),并记录输尿管损伤、膀胱黏膜损伤、继发性出血等并发症情况。结果:置管组的手术时间明显长于无置管组(P<0.01)。2组腺体切除量、膀胱冲洗时间、留置导尿时间、术后住院时间及Hb下降差异均无统计学意义(P>0.05)。2组术后前列腺体积、IPSS评分、QOL评分、Qmax和PVR差异均无统计学意义(P>0.05)。置管组并发症发生率低于无置管组(P<0.05)。结论:通过DJ管的醒目标识作用有利于避免损伤输尿管开口及膀胱三角,使得经尿道巨大前列腺剜除联合粉碎器操作更流畅,输尿管口辨识更加清晰方便,是一种简单易行、安全有效的辅助手段。

Objective:To investigate the approach and application value of DJ-catheter indwelling in transurethral giant prostate enucleation.Methods:Sixty-four patients with giant prostatic hyperplasia were randomly divided into the catheter group and non-catheter group(32 cases in each group).The DJ-catheter was implanted,and applied to the giant prostate enuclator combined with crusher in the catheter group,while the non-catheter group were treated with the giant prostate enucleation combined with morcellator.The operative time,gland quality of excision,bladder irrigation time,indwelling time of urinary catheter,postoperative hospital stay,decreased hemoglobin(Hb),and international prostate symptom score(IPSS),quality of life index score(QOL),maximum urine flow rate(Qmax)and residual urine(PVR)after 6 months of surgery were compared between two groups.The ureteral injury situation,bladder mucosa damage,secondary bleeding and other complications in two groups were recorded.Results:The operative time in catheter group was significantly longer than that in non-catheter group(P<0.01).The differences of the amount of gland excision,bladder irrigation time,indwelling catheter time,postoperative hospital stay and Hb decreasing between two groups were not statistically significant(P>0.05).The differences of the prostate volume,IPSS score,QOL score,Qmax and PVR between two groups were not statistically significant after 6 months of surgery(P>0.05).The incidence rate of complications in catheter group was lower than that in non-catheter group(P<0.05).Conclusions:DJ-catheter is a simple,safe and effective auxiliary means to avoid damage to the ureteral opening and bladder triangle,and which can make the operation of transurethral giant prostate enucleation combined with morcellator more smooth,and the identification of ureteral orifice more clear and convenient.