發(fā)布時(shí)間：2018-02-26 19:45

  本文關(guān)鍵詞： 前列腺增生 等離子電切術(shù) 術(shù)后出血 出血原因 預(yù)防 治療　出處：《泰山醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:良性前列腺增生(BPH)為最常見(jiàn)的老年男性疾病,分析與總結(jié)經(jīng)尿道等離子雙極電切術(shù)(TUPKP)治療良性前列腺增生術(shù)后出血原因及防治方法,評(píng)價(jià)經(jīng)尿道等離子電切術(shù)治療前列腺增生癥患者的療效及手術(shù)安全性,為泌尿外科微創(chuàng)技術(shù)治療前列腺增生癥患者選擇最佳的手術(shù)方式及治療方案。方法:回顧性分析了自2006年6月至2013年11月間經(jīng)尿道前列腺等離子電切術(shù)治療前列腺增生手術(shù)850例,所有患者術(shù)前均有典型前列腺增生相關(guān)癥狀,其癥狀與前列腺增生后體積不成正比,輔助檢查如彩超、尿流動(dòng)力學(xué)及肛門指診等,術(shù)后所有組織病理學(xué)檢查證實(shí)均為前列腺增生。術(shù)后出血的前列腺增生患者30例,年齡55-78歲,平均年齡65.8歲,病程1-5年,平均2.6年。經(jīng)尿道前列腺等離子電切術(shù)后出血患者的臨床資料,分析總結(jié)患者出血原因、治療及預(yù)防方法。根據(jù)出血量多少情況進(jìn)行分組,出血測(cè)定應(yīng)用MACRO精子計(jì)數(shù)器觀測(cè),導(dǎo)出公式為:含血量(ml)=液體量(ml)×平均每小格紅細(xì)胞數(shù)×107每毫升血中紅細(xì)胞數(shù))分成兩組,以沖洗液中30ml/h含血量為標(biāo)準(zhǔn),其中對(duì)照組出血量小于標(biāo)準(zhǔn)量采用保守治療,觀察組出血量大于標(biāo)準(zhǔn)量采用返回手術(shù)室進(jìn)行治療,觀察兩組的治療效果和止血情況。結(jié)果:30例患者術(shù)后出血均止血成功。術(shù)后給予相同膀胱沖洗速度,沖洗速度為6000ml/6h,并且化驗(yàn)?zāi)虺Ｒ?guī)及血常規(guī),血常規(guī)均在正常范圍。按照術(shù)后出血量計(jì)算結(jié)果情況進(jìn)行分組,其中對(duì)照組出血量小,為沖洗液呈淡紅色者20例,應(yīng)用MACRO方法計(jì)算失血量均30ml/h,年齡46-57歲,平均年齡為(56.5±8.3)歲;體重48-65kg,平均體重(53.57±6.43)kg,病程1-4年,平均病程(1.56±1.03)年,出血時(shí)間術(shù)后2-4h內(nèi)10例,術(shù)后7d內(nèi)6例,術(shù)后3個(gè)月內(nèi)4例。觀察組出血量大,沖洗液呈鮮紅色者10例,應(yīng)用MACRO方法計(jì)算失血量均30ml/h,年齡55-78歲,平均年齡為(67.6±8.4)歲;體重57-76kg,平均體重(64.36±6.59)kg,病程1-5年,平均病程(2.62±1.06)年,出血時(shí)間術(shù)后2-4h內(nèi)7例,術(shù)后7d內(nèi)2例,術(shù)后3個(gè)月內(nèi)1例。治療原則同一般性血尿,必要給予如手術(shù)室行膀胱鏡檢查或電凝止血,重點(diǎn)為治療誘發(fā)前列腺電切術(shù)后出血的原發(fā)病及出血原因的預(yù)防及治療。經(jīng)過(guò)綜合分析術(shù)后出血原因?yàn)?(1)術(shù)前有基礎(chǔ)疾病(如冠心病10例次、糖尿病9例次、泌尿系感染10例次、高血壓13例次、慢性支氣管炎及肺氣腫5例次及各種原因?qū)е碌哪冈娱L(zhǎng)及出血傾向)。(2)術(shù)中前列腺切除不徹底,殘留前列腺組織過(guò)多,術(shù)后前列腺窩發(fā)生感染,術(shù)中損傷前列腺包膜、止血不徹底等。(3)術(shù)后過(guò)度活動(dòng)、疼痛及腹壓增加、用力不當(dāng)、便秘等因素有關(guān),術(shù)后應(yīng)激反應(yīng)等造成凝血功能下降。結(jié)論:經(jīng)尿道前列腺等離子電切術(shù)后出血原因及止血效果比較和評(píng)價(jià),術(shù)前、術(shù)中、術(shù)后及時(shí)準(zhǔn)確處理是減少術(shù)后出血的非常關(guān)鍵因素,基本表現(xiàn)為三類:(1)、術(shù)前準(zhǔn)備匆忙不充分,(2)、術(shù)中操作欠規(guī)范或手術(shù)者掌握手術(shù)程度不熟練,(3)、術(shù)后觀察處理不及時(shí)。術(shù)前完善各項(xiàng)必要檢查,手術(shù)適應(yīng)癥必須嚴(yán)格把關(guān);術(shù)中規(guī)范操作,手術(shù)者必須能夠熟練掌握手術(shù)操作,以精阜為標(biāo)志,切除前列腺到外包膜,切除創(chuàng)面平整,止血徹底;術(shù)后及時(shí)觀察對(duì)癥處理,抗生素應(yīng)用預(yù)防感染,做好病人的指導(dǎo)工作。輕度出血可采用保守治療,給予加大膀胱沖洗速度,保持各引流管通暢,口服止血藥物如云南白藥膠囊等,治療基礎(chǔ)病或原發(fā)病;重度出血可以給予應(yīng)用靜脈止血藥物如血凝酶等、補(bǔ)足血容量及快速膀胱沖洗等,如血凝塊發(fā)生膀胱填塞時(shí)應(yīng)及時(shí)清除血凝塊,有明顯出血者給予手術(shù)電灼止血,當(dāng)病人無(wú)明顯出血后重新放置導(dǎo)尿管,保持膀胱沖洗和引流通暢。
[Abstract]:Objective: benign prostatic hyperplasia (BPH) is the most common disease of older men, the analysis and summary of transurethral plasmakinetic resection (TUPKP) causes and methods of prevention and treatment of bleeding after transurethral prostatectomy, evaluate the efficacy and safety of surgical resection for the treatment of benign prostatic hyperplasia with transurethral plasmakinetic, minimally invasive technique for Department of Urology the treatment of benign prostatic hyperplasia patients choose the best surgical approach and treatment. Methods: a retrospective analysis from June 2006 to November 2013 between transurethral plasmakinetic resection of prostate for treatment of benign prostatic hyperplasia surgery in 850 cases, all patients had typical hyperplasia of prostate related symptoms, the symptoms and hyperplasia of prostate gland is not proportional to the auxiliary examination such as ultrasound, urodynamics and DRE, postoperative histopathological examination confirmed prostatic hyperplasia after blood prostate. 30 cases of patients with hyperplasia, 55-78 years of age, the average age of 65.8 years, the duration of 1-5 years, an average of 2.6 years. The clinical data of patients with hemorrhage after transurethral resection of prostate, analysis the reasons of hemorrhage, prevention and treatment methods. Group according to how much the amount of bleeding, bleeding by MACRO sperm counter observation, export formula: blood containing liquid volume (ML) = (ML) * the average number of red blood cells * 107 cells per milliliter of blood red blood cells) were divided into two groups, with washing liquid blood containing 30ml/h as the standard, the control group was less than the standard amount of bleeding with the conservative treatment, observation group on bleeding volume the amount of the standard return operation room for treatment, observe the curative effect and hemostasis in two groups. Results: 30 cases of patients with postoperative bleeding was successful. After given the same bladder washing speed, flushing rate is 6000ml/6h, and testing urine and blood often 瑙，

本文編號(hào)：1539444