80岁以上高龄膀胱造瘘术后良性前列腺增生患者择期行经尿道前列腺切除术围手术期的安全性观察  

Observation on perioperative security of selective transurethral resection of prostate for octogenarian benign prostatic hyperplasia patients after cystostomy

作　　者：谢满平 李建忠 任恒宽 单魏 武赞仁 魏永俭 

机构地区：[1]民乐县中医医院,甘肃民乐734500

出　　处：《腹腔镜外科杂志》2009年第11期833-835,共3页Journal of Laparoscopic Surgery

摘　　要：目的:比较高龄膀胱造瘘术后良性前列腺增生(benign prostatic hyperplasia,BPH)患者择期行经尿道前列腺切除术(transurethral resection of prostate,TURP)与未造瘘患者围手术期的情况,研究膀胱造瘘术后择期为80岁以上高龄BPH患者行TURP的安全性。方法:2007年4月至2009年5月我院为30例80岁以上置入导尿管困难的BPH患者先行膀胱造瘘术,后择期行TURP,30例未造瘘者急症或择期行TURP,比较两组患者的术前评估(ASA评分),术前并存症,术后并发症,术中及术后血流动力学变化等围手术期情况。结果:术前两组ASA评分和伴随的并存症发生率差异无统计学意义。未造瘘组患者术中10min,术后15min心率、血压、血氧饱和度、呼吸次数及心电图明显异常,两组术前5min均无明显异常。造瘘组无一例发生电切综合征,未造瘘组2例发生电切综合征,造瘘组并发症发生率显著低于未造瘘组,两组手术死亡率差异无统计学意义。结论:膀胱造瘘术后高龄BPH患者择期行TURP比未造瘘者安全,效果好,膀胱造瘘管作为主要出水管,低压灌注,无电切综合征发生,血流动力学变化小,生活方便,痛苦少,感染率与死亡率低,远期生活质量较好。Objective：To compare perioperative situation of octogenarian benign prostatic hyperplasia（BPH） patients who underwent transurethral resection of prostate（TURP） with or without cystostomy,and study the safety of elective TURP for octogenarian BPH patients after cystostomy.Methods：From Apr.2007 to May 2009,30 BPH patients（over 80 years） who could not be inserted the catheter underwent cystostomy and a later elective TURP.30 cases without cystostomy underwent emergency or elective TURP.The perioperative indexes of 2 groups were compared,for instance,preoperative complication and evaluation（ASA grade）,postoperative complication,intraoperative and postoperative hemodynamics changes.Results：The differences of preoperative ASA grade and complication incidence in 2 groups were not significant.As for the patients without cystostomy,the heart rate,blood pressure,blood oxygen saturation,respiration rate and electrocardiogram were significantly abnormal in 10min during operation and 15min after operation.There were no significant differences between 2 groups at 5min before operation.Transurethral resection syndrome was not found in anyone with cystostomy and 2 patients without cystostomy.The complication incidence was much lower for patients with cystostomy than that without cystostomy.The difference of death rate between 2 groups was not significant.Conclusions：It is safer and more effective of aged BPH patients with cystostomy to be performed elective TURP than patients without cystostomy.Bladder fistula as main excurrent canal with low irrigation pressure,small hemodynamic change and no transurethral resection syndrome,the patients can live an easier and less painful life.Their incidence of infection and death is lower and they have a better long-term life quality.

关 键 词：膀胱造口术 前列腺增生 经尿道前列腺切除术 老年人 血流动力学 

分 类 号：R699[医药卫生—泌尿科学]