电切镜与金属空心尿管在膀胱填塞中的应用效果研究  

Comparison of resectoscope added Ellic evacuator or hollow metal catheter for treatment of bladder clot retention

作　　者：周红庆[1] 邵涛[1] 刘明生[1] 张小德[1] 许陈祥[1] 邓体斌 吴尧[1] Zhou Hong-qing;Shao Tao;Liu Ming-sheng;Zhang Xiao-de;Xu Chen-xiang;Deng Ti-bin;Wu Yao(Department of invisave urology,The first people’s Hospital of Qu jing,Qujing,Yunnan,655000,China)

机构地区：[1]云南省曲靖市第一人民医院微创泌尿外科,云南曲靖655000

出　　处：《当代医学》2017年第9期1-4,共4页Contemporary Medicine

摘　　要：目的探讨电切镜加ELLIC冲洗器与金属空心尿管在膀胱填塞中的应用效果,以分析两种处理方式优缺点,。方法统计云南省曲靖市第一人民医院微创泌尿外科9年来处理膀胱填塞患者共87例,其中采用电切镜配合ELLIC冲洗器清除血块45例,采用金属空心尿管处理患者42例。电切镜组先用电切环将膀胱血块分块切割后换用ELLIC冲洗器清除血块,检查有活动性出血患者电切镜下止血,直视下观察至膀胱内血块清除后留置一22F双腔尿管接持续膀胱冲洗;金属空心尿管处理组采用金属空心尿管接20 m L注射器反复抽吸将血块逐渐碎屑化后吸出,配合反复少量注水加抽吸有助于将血块顺利吸出,待冲洗与抽吸均顺利,膀胱区膨隆消失后留置一22F双腔尿管持续膀胱冲洗。比较两组不同处理方式的手术时间、术后冲洗时间、有效率、再次出血例数、患者投诉例数。结果 87例膀胱填塞患者均能通过两种不同方法顺利清除血块。两组患者处理后再次出血分别为4例(8.89%)、7例(16.7%)。手术有效率两组分别为100%、95.2%。两组患者手术时间分别为(53.2±6.5)min、(45.1±5.5)min,术后冲洗时间为(21.4±3.0)h、(22.7±2.8)h。手术投诉率两组分别为13.3%、2.3%。两组患者在术后再次出血、术后冲洗时间上比较差异无统计学意义,但通过金属空心尿管清除血块患者在手术时间上较经尿道电切镜处理组比较差异有统计学意义(P<0.05),患者投诉率亦明显较前者减少。结论膀胱填塞是泌尿外科常见急症。电切镜鞘配合ELLIC冲洗器及金属空心尿管均可有效清除膀胱内血块,电切镜鞘下直观、可视,并可有效处理活动性出血,但多需在硬膜外麻下进行;金属空心尿管可在床旁局麻下进行,从而可尽快解决患者痛苦,减少患者二次手术之苦,同时可有效减少医疗投诉隐患。Objective To discuss the different efficacy of using urethral resectoscope added Ellic evacuator or hollow metal catheter in bladderclot retention.Methods87cases of bladder clot retention were devided into2groups.One group45cases were treated with urethral resectoscopeadded Ellic evacuator.In the operaton the clots can be broken using a resectoscope loop and then evacuated with Ellic evacuator,after that,each patientwas placed a22F cather and irrigated continuously;the other group42cases were treated with hollow metal catheter,each patient was placed aFoley catheter(22F)and irrigated continuously after the suction was easy and the filling of bladder vanished.Which means the block had been evacuated.The operation time、effective rate rebleeding number、and the patient numbers of compliment were Analyzed in2groups.Results87caseswere all safe and effective through two different methods.The rehemorrhage case comparison is4(8.89%)vs7(16.7%).The effective rate of operationcomparison is100%vs95.2%.The The operation time comparison is(53.2±6.5)min vs(45.1±5.5)min.The postoperative irrigate time comparisonis(21.4±3.0)h vs(22.7±2.8)h.Complaint rate comparison is13.3%vs2.3%.There is no significant difference between two groups in rehemorrhagerate and postoperative irrigate time,but the group with hollow metal catheter has less operation time(P<0.05)and less complaint.ConclusionBladder clot retention is regarded as a urological emergency.resectoscope added Ellic evacuator cr hollow metal catheter are two different effectivemethods in clearing the bladder clot.the first one has a visible advantages ang also can treat the active bleeding.But need the patient under anethesia.The later one can remove the patients compliment rapidly、avoiding the operation、reducing the related complain.It also can treat patient at bedsidewithought anethesia.

关 键 词：膀胱填塞 金属导尿管 前列腺电切术 治疗 

分 类 号：R699.5[医药卫生—泌尿科学]