经尿道电汽化前列腺切除术电切综合征(附19例报告)

TURS during transurethral vaporization of the prostate(report of 19 cases)

目的 探讨经尿道电汽化前列腺切除术 (TUVP)经尿道电切综合征 (TURS)的诊治经验。 方法 应用单纯汽化电极和汽化切割电极共行TUVP术 2 13例 ,其中 19例 (8.9% )手术结束时血清钠值 <12 5mmol/L ,回顾性分析 19例患者手术、监护、临床检验资料。 结果 19例平均手术时间 79min ,平均失血 156ml ,前列腺包膜切破 4例 (2 1% ) ,切割获取前列腺组织平均重 2 0 .7g。19例手术结束时血清钠值较术前 (13 6.9± 3 .9)mmol/L下降 (15.8± 5.8)mmol/L ,差异有显著性意义 (P <0 .0 0 1)。血Hb下降 (16.0± 8.5) g/L(P <0 .0 1)。血HCT下降 (3 .68± 8.3 0 ) % (P >0 .0 5)。11例 (57.9% )无不适症状 (2例中心静脉压曾明显升高 ) ;8例 (42 .1% )有呕吐、烦躁、心动过缓、低血压、寒战等症状 (7例中心静脉压曾明显升高 ) ,经应用利尿剂等好转。 结论 TUVP手术仍有发生TURS的危险 ,尤其在手术时间长、前列腺包膜切破、术中失血增多时。密切监视中心静脉压、血清钠及患者对手术的副反应 。

Objective To summerize the therapeutic ex pe rience of TURS during transurethral vaporization of the prostate (TUVP). Methods Among the consecutive 213 patients who underwent TUVP from February 1998 to February 2003,using vaporization electrode and vapori-res ection electrode,none had significant TURS,but 19 men (8.9%) had serum sodium le vels<125 mmol/L at the end of operation.The data of operation,monitor,clinical t est of the 19 men were reviewed retrospectively. Results Of the 19 patients,mean operative time was 79 minutes,average blood loss was 1 56 ml,the prostatic capsule was perforated in 4 cases (21%),the resected BPH tis sue weighed 20.7 g in average.At the end of the operation,the serum sodium and h emoglobin levels declined (15.8±5.8)mmol/L( P <0.001) and (16±8.5)g/L( P < 0.01) respectively,whereas the hematocrit declined (3.68±8.30)% ( P >0.05).11 cases (57.9%) had no symptoms (abnormal CVP in 2 cases). 8 cases (42.1%) had on e or several transient (< 5 minutes) symtoms,included vomiting,fidgeting,bradyca rdia,hypotension,chills,etc (abnormal CVP in 7 cases). Conclusions Although TUVP can decrease fluid absorption, the risk of TURS present still,especially the operation time prolonged,prostatic capsule perforated,bloo d loss increased.Keep close watch over CVP,serum sodium level and patient’s sig ns,TURS be could avoid.