内腔镜手术监测仪在前列腺等离子切除术中应用的临床效果评价  

Clinical application value of the endoscopic surveillance system in transurethral bipolar plasmakinetic resection of the prostate

作　　者：汪林军 王志平[1,2,3] 包军胜[1,2,3] 米军[1,2,3] WANG Lin-jun;WANG Zhi-ping;BAO Jun-sheng;MI Jun(Research Institute of Urology,2.Key Laboratory of Gansu Province for Urological Diseases,3.Clinical Center of Gansu Province for Urological Diseases,Lanzhou University Second Hospital,Lanzhou,Gansu 730030,China)

机构地区：[1]兰州大学第二医院泌尿外科研究所,甘肃兰州730030 [2]兰州大学第二医院甘肃省泌尿系疾病重点实验室,甘肃兰州730030 [3]兰州大学第二医院甘肃省泌尿系疾病临床医学中心,甘肃兰州730030

出　　处：《中华男科学杂志》2020年第5期414-421,共8页National Journal of Andrology

基　　金：甘肃省卫生行业科研计划项目(GSWSKY2017-07)。

摘　　要：目的:探讨内腔镜手术监测仪在经尿道前列腺等离子切除术中应用的临床价值。方法:回顾性分析2018年9月至2019年3月在内腔镜手术监测仪监测下行经尿道前列腺等离子切除术的136例患者,按照前列腺体积大小分为PV≥60 ml组和PV<60 ml组,分别观察两组患者手术时间、术中出血、冲洗液吸收量等围手术期指标的变化。结果:136例患者均完成手术,无中转开放及终止手术的患者。PV≥60 ml组vsPV<60 ml组:手术时间为(78.93±28.63) minvs(51.77±14.85) min、术中出血量为(261.61±204.25) mlvs(69.26±61.13) ml、冲洗液吸收量为(948.20±656.00) mlvs(347.39±256.53) ml均有统计学意义(P<0.05);术后红细胞、血红蛋白、红细胞压积、离子、住院时间、前列腺穿孔、输血均无统计学意义(P>0.05)。136例患者术前与术后指标比较:红细胞(1012/L)4.62±0.63vs4.31±0.74、血红蛋白(g/L) 141.83±18.30vs135.20±19.91、K+(mmol/L) 4.01±0.43vs3.92±0.54、Na+(mmol/L)141.90±3.11vs139.42±3.81均有统计学意义(P<0.05);Cl-(mmol/L)103.74±9.32vs103.70±4.50、Ca^2+(mmol/L)2.21±0.13vs2.19±0.21均无统计学意义(P>0.05)。结论:大体积BPH患者,由于手术时间长、增生腺体血供丰富,PKRP术中冲洗液大量吸收导致循环超负荷,诱发左心衰竭及肺水肿和大量出血的风险仍然存在。内腔镜手术监测仪可及时发现冲洗液的吸收量及出血量,减少手术并发症,提高手术安全性,建议在PKRP术中推广应用。Objective:To evaluate the clinical application of the endoscopic surveillance system(ESS) in transurethral bipolar plasmakinetic resection of the prostate(TUPKRP). Methods: We retrospectively analyzed 136 cases of TUPKRP performed with the assistance of ESS from September 2018 to March 2019. According to the prostate volume(PV), we divided the patients into a PV ≥ 60 ml and a PV < 60 ml group, and compared the surgery-related parameters between the two groups of patients. Results: Operations were successfully completed in all the 136 cases. Statistically significant differences were observed between the PV ≥ 60 ml and a PV < 60 ml groups in the operation time([78.93 ± 28.63] vs [51.77 ± 14.85] min, P < 0.05), intraoperative blood loss([261.61 ± 204.25] vs [69.26 ± 61.13] ml, P < 0.05) and absorption of the rinse fluid([948.20 ± 656.00] vs [347.39 ± 256.53] ml, P < 0.05), but not in the postoperative red cell count, levels of hemoglobin, hematocrit and ions, hospital stay, incidence of prostatic perforation or blood transfusion(P > 0.05). The patients also showed statistically significant differences between the baseline and postoperative parameters in red cell count([4.62 ± 0.63] vs [4.31 ± 0.74] ×1012/L, P < 0.05) and levels of hemoglobin([141.83 ± 18.30] vs [135.20 ± 19.91] g/L, P < 0.05), K+([4.01 ± 0.43] vs [3.92 ± 0.54] mmol/L, P < 0.05) and Na+([141.90 ± 3.11] vs [139.42 ± 3.81] mmol/L, P < 0.05), but not in the levels of Cl-([103.74 ± 9.32] vs [103.70 ± 4.50] mmol/L, P > 0.05) and Ca2+([2.21 ± 0.13] vs [2.19 ± 0.21] mmol/L, P > 0.05). Conclusion: Large-volume absorption of rinse fluid may overburden the circulatory system and induce left ventricular failure, pulmonary edema or massive bleeding during PKRP for patients with PV ≥ 60 ml due to long operation time and rich blood supply in the hyperplasia gland. The endoscopic surveillance system can provide real-time data on the absorption of rinse fluid and bleeding, reduce complications, and improve surgical safety.

关 键 词：内腔镜手术监测仪 经尿道前列腺等离子切除术 经尿道电切综合征 

分 类 号：R699.8[医药卫生—泌尿科学]