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目的:观察合并高麻醉风险的BPH患者术前短期戈舍瑞林注射结合等离子前列腺电切(PKRP)术的临床疗效,评价其临床意义。方法:将13例ASA分级为Ⅲ级的BPH患者作为治疗组,另选13例前列腺体积类似的患者作为对照组纳入研究。治疗组患者术前3个月每月皮下注射醋酸戈舍瑞林(ZOLADEX)3.6 mg,并在用药前、后行经直肠前列腺B超评估前列腺体积、前列腺内最大血流流速及血管阻力,记录醋酸戈舍瑞林治疗过程中的不良反应。两组均使用Gyrus等离子前列腺电切系统行PKRP术。记录两组手术时间、围手术期并发症发生率、术后血钠水平、术后血红蛋白下降幅度、住院时间及导尿管留置时间。结果:醋酸戈舍瑞林治疗前平均血清PSA为6.98μg/L,PSAD为0.1;药物治疗前平均前列腺体积为68.64ml,治疗后前列腺体积为47.40ml(P<0.01)。醋酸戈舍瑞林治疗后平均前列腺内最大血流速度由24.05ml/s下降为13.05ml/s(P<0.01),前列腺内血管阻力指数由0.73下降为0.65(P<0.01);无因严重不良反应终止药物治疗患者;术前2例有勃起功能的患者使用醋酸戈舍瑞林过程中勃起功能丧失,其中1例停药后恢复。平均手术时间治疗组为35min,对照组为52min(P<0.01)。两组围手术期均无呼吸循环系统并发症发生。治疗组术后平均血红蛋白下降9.5g/L,对照组为1.28g/L(P=0.004)。治疗组11例术后72h拔除导尿,2例拔除导尿后出现尿潴留,平均住院时间3d;1例术后3个月因尿道狭窄行尿道内切开术,术后定期尿道扩张。对照组1例术后4周出现尿潴留,平均住院时间与治疗组相同。结论:对因合并高危麻醉风险而无法行传统单极TURP术的BPH患者,术前短期(3个月)使用醋酸戈舍瑞林是一种安全有效合理的外科辅助治疗方案,结合PKRP技术使手术治疗更为安全。
Objective: To observe the clinical efficacy of preoperative short-term goserelin injection combined with plasma prostatectomy (PKRP) in BPH patients with high risk of anesthesia and evaluate its clinical significance. Methods: Thirteen BPH patients with ASA grade Ⅲ were selected as the treatment group. Thirteen patients with the same volume of prostate were selected as the control group. The patients in the treatment group were subcutaneously injected with 3.6 mg of ZOLADEX once a month for 3 months before operation. Prostate volume, the maximum blood flow velocity in the prostate, and vascular resistance were measured before and after transrectal prostate injection. Acetic acid Adverse reactions during goserelin treatment. Gyrus plasma prostatectomy system was used in both groups for PKRP. The operation time, the incidence of perioperative complications, postoperative serum sodium level, postoperative hemoglobin decline, hospital stay and urinary catheter retention time were recorded. Results: Before treatment, the mean serum PSA was 6.98 μg / L and the PSAD was 0.1. The average volume of prostate before treatment was 68.64 ml, and the volume of prostate after treatment was 47.40 ml (P <0.01). The mean maximum blood flow velocity in the prostate decreased from 24.05ml / s to 13.05ml / s after goserelin acetate treatment (P <0.01), while the intra-prostatic vascular resistance index decreased from 0.73 to 0.65 (P <0.01) Adverse reactions terminated the drug treatment of patients; two patients with erectile dysfunction before elective use of goserelin acetate during erectile dysfunction, including one case recovered after withdrawal. The mean operative time was 35 minutes in the treatment group and 52 minutes in the control group (P <0.01). No complications of the respiratory system occurred during the perioperative period in both groups. The average postoperative hemoglobin decreased 9.5g / L in the treatment group and 1.28g / L in the control group (P = 0.004). In the treatment group, 11 patients underwent catheterization at 72h after operation, urinary retention was found in 2 patients after catheterization, and the average hospital stay was 3 days. One patient underwent urethral incision for urethral stricture 3 months after operation, and regular urethral dilation. One case of control group had urinary retention after 4 weeks, and the average length of hospital stay was the same as that of the treatment group. CONCLUSIONS: Goserelin acetate is a safe and effective surgical adjuvant therapy for short term (3 months) preoperative BPH in patients with BPH who are unable to undergo traditional unipolar TURP because of the risk of high-risk anesthesia. In combination with PKRP Surgical treatment more secure.