前列腺电切术中防治TURS的临床探讨（附712例病例报告）

Investigation of operative techniques and other relative factors to prevent transurethral resection syndrome

关键词:  前列腺增生  电切综合征  经尿道前列腺电切术

Key words:  BPH  TURS  transurethral resection of the prostate

摘要:

［目的］探讨有效防止TURS的前列腺电切手术技巧及处理手段。［方法］回顾分析712例前列腺电切及电汽化患者的TURS发生情况、影响因素、手术的相关技巧及应对策略。［结果］腺体均切至外科包膜，早期313例ＴＵＲＰ患者中有16例发生TURS(5.1%),后期TURP结合TVP399例，发生TURS者8例（2%），TURP组和TURP结合TVP组，出现TURS的几率差异有显著性意义。712例患者手术时间为25～180 min，平均(110.5±25.9)min,其中24例TURS发生的手术时间90～180 min，平均(146.3±32.2)min，全部病例中包膜穿孔或临界穿孔者45例，发生TURS者24例，严重尿外渗者11例，包膜穿孔和手术时间对TURS的影响差异有显著性意义。24例TURS患者全部抢救成功。［结论］尽量避免包膜早期穿孔和手术时间过长是有效防止TURS的重要手段，出现严重尿外渗、腹腔渗液时穿刺置管引流是有效的微创治疗手段。

Abstract:

［Objective］To investigate the opeative techniques and other relative factors to prevent transurethral resection syndrome .［Methods］The clinieal characters of TURS,operative techniques mere retrospeetiely analysed in 712 coses ceperiening TURP of TVP.［Results］Among 313 TURP cases,16 cases were recognized as having TURS(5.1%),and among 399 TVP cases ,8 cases TURS(2%).There were 45 cases with perforation of prostate capsule ,and 24 cases of them display symptoms of TURS.All the TURS patients recover through using diuretic,sodium solution,dexemethason and other treatments.［Conclusions］The occurence of TURS during TURP was highly related with surgical techniques,especially avoiding the eraly perforation of prostate capsule.It is helpful to keep close watch over pre-TURS symptoms, and CVP for early recognization of TURS.