选择性绿激光前列腺汽化术患者围手术期维持口服抗凝药的安全性与手术效果探讨  

Safety and effectiveness of green light photoselective vaporization of prostate for patients ongoing oral anticoagulation in perioperative period

作　　者：雒向宁[1] 王禾[2] 杨波[2] 

机构地区：[1]陕西中医学院附属第一医院泌尿外科,陕西咸阳712000 [2]第四军医大学附属西京医院泌尿外科,陕西西安710033

出　　处：《中国现代医学杂志》2012年第15期84-87,共4页China Journal of Modern Medicine

摘　　要：目的前列腺增生患者围手术期不停用口服抗凝药物的情况下,采用选择性绿激光前列腺汽化术,并对其安全性与临床效果进行评估。方法术前合并心血管疾病而持续口服抗凝药物的前列腺增生患者共59例,16例服用华法令,37例服用阿司匹林,6例服用氯吡格雷。手术方式均为选择性绿激光前列腺汽化术。其中,试验组28例,围手术期维持口服抗凝药物;对照组31例,围手术期间停用抗凝药物。对两组患者围手术期观察指标与术后排尿改善情况等进行比较,随访时间至术后6个月。结果 59例患者围手术期间均未输血,心血管疾病病情无加重。试验组与对照组比较,术前前列腺体积、手术时间之间无显著性差异(P>0.05)。术后留置尿管时间,试验组多于对照组(P<0.05),术后随访6个月,两组前列腺症状评分及最大尿流率相近(P>0.05)。结论选择性绿激光前列腺汽化术具有良好的止血特性,并未增加口服抗凝药物患者术后继发出血的风险。因此,对于需要在围手术期间持续口服抗凝药物的前列腺增生患者,选择性绿激光前列腺汽化术是相对安全的手术方式。【Objective】 Ongoing oral anticoagulation（OA） contraindicates transurethral electroresection of the prostate.We evaluated the safety and effectiveness of photoselective vaporization of the prostate（PVP） in patients of benign prostatic hyperplasia（BPH） on ongoing OA in perioperative period.【Methods】 A total of 59 patients with BPH combined with cardiovascular disease,which on ongoing OA.There were 16 cases receiving coumarone,37 cases receiving aspirin and 6 cases receiving clopidogrel.We evaluated perioperative parameters,functional outcome,and adverse events up to 6 mo postoperatively of 28 patients on OA（test group）,and compared results with 31 patients at normal risk without anticoagulant therapy（control group）,undergoing PVP.【Results】 All the 59 patients safely got through perioperative period.The preoperative concurrent cardiovascular diseases were not aggravated after PVP operation.No cases had to need blood transfusion.As the mean volume of prostate preoperatively and the mean operative time,there were no significant differences between the two groups（P 〉0.05）.In test group the catheterization time postoperatively was longer than in control group（P 〈0.05）.At 6mo postoperatively,improvement of the International Prostate Symptom Score and average maximum urinary flow rate were similar between the two groups（P 〉0.05）.【Conclusion】 PVP is characterized by excellent haemostatic properties and very low intraoperative complication rate even in patients on OA.On the basis of our perioperative results,PVP would be as safe procedure for patients with BPH who need ongoing OA in perioperative period.

关 键 词：前列腺增生症 抗凝药物 绿激光 

分 类 号：R697.3[医药卫生—泌尿科学]