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目的探讨前列腺体积>60 mL的前列腺增生症患者的手术安全性,提高部分合并尿道狭窄前列腺增生症患者的手术实施率。方法 2009年3月-2010年3月,行耻骨上膀胱穿刺引流下经尿道前列腺电切术(TURP)治疗前列腺增生58例。年龄54～93岁,平均72岁,病程8个月～12年,平均7.2年;前列腺体积35～128 mL,平均78 mL;国际前列腺症状评分24～35分,平均30.2分;最大尿流率1.2～4.8 mL/s,平均1.8 mL/s;残余尿量84～210 mL,平均160 mL。术前无尿潴留28例。结果 58例顺利完成手术,其中2例伴包膜穿孔,9例前尿道狭窄者通过去外鞘电切镜完成手术。所有患者切除前列腺组织体积18～86 mL,平均58 mL;术中冲洗液为5%葡萄糖液,用量18 600～42 500 mL,平均23 500 mL;手术时间45～185 min,平均70 min。术后病理检查均示良性前列腺增生,术后住院时间3～8 d,平均5 d。术后患者最大尿流率为18～46 mL/s,平均32 mL/s。结论耻骨上膀胱穿刺引流能降低膀胱内压,减少水、糖分吸收,增加手术安全性,提高了部分合并前尿道狭窄的前列腺增生患者的手术几率。
Objective To investigate the surgical safety of benign prostatic hyperplasia patients with prostate volume> 60 mL, and to improve the operative rate in some patients with prostatic hyperplasia complicated by urethral stricture. Methods From March 2009 to March 2010, 58 cases of benign prostatic hyperplasia (BPH) underwent transurethral resection of the bladder by transurethral resection of the prostate (TURP). Aged 54 to 93 years, mean 72 years, duration of 8 months to 12 years, an average of 7.2 years; prostate volume 35 ~ 128 mL, an average of 78 mL; International Prostate Symptoms score 24 to 35 points, an average of 30.2 points; 1.2 ~ 4.8 mL / s, an average of 1.8 mL / s; residual urine volume 84 ~ 210 mL, an average of 160 mL. Preoperative no urinary retention in 28 cases. Results 58 cases completed the operation successfully, of which 2 cases with perforation of the capsule, 9 cases of anterior urethral stricture by to go to the sheath resectoscope to complete the operation. All patients underwent resection of prostate tissue volume 18-86 mL with an average of 58 mL. The intraoperative irrigation fluid was 5% dextrose solution in an amount of 18 600-42 500 mL, with an average of 23 500 mL. The operation time was 45-185 min with an average of 70 min. Postoperative pathological examination showed benign prostatic hyperplasia, postoperative hospital stay 3 ~ 8 d, an average of 5 d. The maximal urinary flow rate after operation was 18-46 mL / s, with an average of 32 mL / s. Conclusion Puncture of suprapubic bladder puncture can reduce intravesical pressure, reduce water and sugar absorption, increase surgical safety and improve the chances of partial prostatectomy in patients with pre-urethral stricture.