【作者】 张伟；

【导师】 侯四川；

【作者基本信息】 泰山医学院 ， 外科学， 2012， 硕士

【摘要】 目的：良性前列腺增生(BPH)是常见的老年疾病,经尿道前列腺电切术(TURP)为治疗前列腺增生的金标准。术后前列腺出血是TURP最主要的并发症之一,按出血时间可分为近期出血和远期出血两种。近期出血是指术后1-7天的出血,远期出血是指术后7-14天以及更长时间后出现的出血。远期出血虽然发生率较低,但原因复杂。通过回顾分析,探讨TURP术后远期出血原因及治疗,进一步提高手术安全性。方法：回顾性分析了1998年-2010年青岛市立医院2500例前列腺增生行TURP术的病人,其中出现远期出血患者41例,36例经保守治疗痊愈,4例手术室清理血凝块,其中电凝止血2例,1例保守治疗好转后再次出血,至手术室电凝止血。本组41例所有出血患者全部成功止血。入选患者均有明确的手术指征,均行TURP手术治疗。所有的病人都行组织病理学检查确诊前列腺增生。分析本组患者出现远期出血的原因及给予的治疗方法。结果：41例患者均止血成功,经综合分析远期出血原因：(1)患者有高血压、糖尿病、脑血栓后遗症、动脉硬化、贫血、肝病、慢性肾功不全、各种原因所致的凝血酶原时间延长和出血倾向等。(2)术中不能完整切除者,切割面不光滑,因残留前列腺腺体或前列腺增生复发,术后发生泌尿系感染；术后应激及其他原因所致自身凝血功能下降。(3)术后出现疼痛、腹内压增高、未得到控制的泌尿系感染、过度活动等。治疗同一般血尿的治疗原则,必要时行膀胱镜检查及电凝止血,治疗重点为诱发远期出血的原发病及原因的控制。结论：TURP术后远期出血的原因从时间上可分为三大类：术前准备不充分、术中操作不规范、术后处理不及时。术前完善各项检查,严格把握手术适应症；术中应规范操作完全切除腺体,尽量保持创面平整,彻底止血；术后及时正确对症治疗,应用抗生素控制感染,做好病人术后及出院后指导工作。TURP术后远期出血的发生是可以控制的。更多还原

【Abstract】 Objective:Benign Prostatic Hyperplasia (BPH) is a common age-related disease. TransUrethral Resection Prostate (TURP) is a gold standard for the treatment of benign prostatic hyperplasia. Prostate bleeding after surgery is one of the most important complications of TURP, which can be divided into short-term and long-term bleeding according to the bleeding time. Short-term bleeding refers to the bleeding of1to7days after surgery; long-term bleeding refers to the bleeding of7to14days or even longer after surgery. Despite of the low possibility of long-term bleeding, the reasons are complicated. By retrospective analysis, the causes and treatment of long-term bleeding after TURP are discussed, to further improve the surgery safety.Methods:2500cases of benign prostatic hyperplasia TURP patients in Qingdao Municipal Hospital from1998to2010are reviewed and analyzed, including41cases of long-term bleeding,36patients cured by conservative treatment,4cases by operating room cleaning up blood clots. Besides, there are2cases by electro cautery,1case of bleeding again after conservative treatment, to the operating room electro cautery. All the41patients in the group were successful in hemostasia. All the selected patients had clear surgery characteristic, undertaking TURP surgery. All the patients conducted histopathological examination to confirm benign prostatic hyperplasia. Here we analyze the reason and treatment method of this group of patients who had long-term bleeding.Results:All the41patients were successful in hemostasia. The reason of long-term bleeding after a comprehensive analysis:(1) patients with hypertension, diabetes, cerebral complications, arteriosclerosis, anemia, liver disease, chronic renal insufficiency, coagulation zymogen time prolonged due to various reasons and bleeding tendencies.(2) patients whose intraoperative resection is not complete, cutting surface is not smooth, due to residual prostate or prostate hyperplasia recurrence, urinary infection occurs after surgery, postoperative stress and decreased coagulation due to other reasons.(3) postoperative pain, increased intra-abdominal pressure, uncontrolled urinary infection, excessive activities and so on. The treatment is the same with the general treatment principles of hematuresis. If necessary, take the cystoscopy examination and electric coagulation. The treatment focuses on the protopathy of treatment long-term bleeding and the control of reason.Conclusion:The reason of TURP postoperative long-term bleeding can be divided into three categories by the time:preoperative inadequate preparation, intraoperative non-standard operation, and postoperative untimely treatment. Perfect various inspection before surgery, and strictly hold the surgical indications; operate normatively during the surgery, remove the gland totally, keep the wound formation, and complete hemostasis; cure timely and correctly after the surgery, apply antibiotics to control infection, and give the patients enough guide after their undergoing surgery and leaving hospital. The occurrence of long-term bleeding after TURP can be controlled,更多还原