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探討經(jīng)尿道前列腺電切術(shù)致水中毒的防治
【摘要】 目的：研究良性前列腺增生（BPH）患者經(jīng)尿道前列腺電切術(shù)（TURP）水中毒預(yù)防與治療的有效方法。方法：分析204例TURP患者中水中毒6例的診治情況。6例年齡69~82歲，平均77.3±2.6歲；前列腺體積60~100ml，平均75.5±15.4ml， 國(guó)際前列腺癥狀評(píng)分24~32分，平均29.3±2.3分，水中毒于手術(shù)開始35~75min，平均45.3±12.5min后出現(xiàn)。采取治療措施：（1）20%甘露醇脫水利尿；（2）補(bǔ)充高滲透壓鈉；（3）糾正低血壓與酸中毒；（4）腹腔或膀胱前間隙穿刺引流積液；（5）立即中止或暫停手術(shù)。結(jié)果：經(jīng)治療后6例生命體征均轉(zhuǎn)為平穩(wěn)，無(wú)嚴(yán)重并發(fā)癥發(fā)生，術(shù)后1個(gè)月隨訪皆排尿暢。結(jié)論： TURP為患者減少創(chuàng)傷、降低住院費(fèi)用、縮短住院時(shí)間、提高療效提供了保證，早發(fā)現(xiàn)早治療水中毒使TURP術(shù)更為安全可靠。【關(guān)鍵詞】 良性前列腺增生；經(jīng)尿道前列腺汽化電切術(shù)；水中毒
The prevention and treatment of overhydration in TURP cases
[Abstract] Objective: To study the prevention and treatment of overhydration in transurethral prostatic resection (TURP) patients. Methods: 6 cases of diagnosing and treating overhydration were analysed. The average age is (77.3±2.6) yrs (69~82yrs), the average volume of prostate was (75.5±15.4) ml (60~100ml), and the international prostatic symptom score was (29.3±2.3) (24~32). The water toxic symptoms began within (35~75min)average (45.3±12.5) min after operation, and the therapeutic measures having been used included: (1) 20% mannitol for anhydration and diuresis; (2)supplying hyperosmosis natrium; (3)correcting hypotension and acidosis; (4)puncturing and draining hydrops of abdominal cavity or prevesical space; (5)stopping or suspending operation immediately. Results: All patients' vital signs turned to stable after treatment, no more severe complications occurred, and the follow-up 1 month after operation showed urinating smoothly. Conclusions: As a golden standard of BPH surgical treatment, the application of TURP may decrease patients' injury, cut down the cost of hospitalization, shorten the length of stay and increase the therapeutic efficacy. If proper protective measures are taken and early diagnosis and early treatment are given for those overhydration patients, the TURP method will be safer and more reliable.
[Key words] Benign prostatic hypertrophy; Transurethral prostatectomy; Overhydration
良性前列腺增生（BPH）患者采用經(jīng)尿道前列腺電切或汽化電切術(shù)（transurethral prostatectomy，TURP）治療。該術(shù)式優(yōu)點(diǎn)為創(chuàng)傷微小、失血量少、住院時(shí)間短、住院費(fèi)用低等。目前它已取代絕大多數(shù)開放手術(shù)，成為多數(shù)中等以上醫(yī)院泌尿外科醫(yī)師的首選治療方案。但TURP式術(shù)中易出現(xiàn)水中毒，即電切過(guò)程中大量水分進(jìn)入循環(huán)系統(tǒng)，導(dǎo)致稀釋性低鈉血癥與心力衰竭。如預(yù)防與處理不當(dāng)，可造成嚴(yán)重后果甚至死亡[1，2]。我院2005年12月~2006年12月對(duì)204例患者施行TURP手術(shù)，其中6例發(fā)生水中毒，經(jīng)緊急處理后取得滿意療效。
1 臨床資料
1．1 一般資料 收治良性前列腺增生202例，因各種原因采用經(jīng)恥骨上經(jīng)膀胱摘除手術(shù)3例，經(jīng)尿道前列腺電切或汽化電切術(shù)199例；前列腺癌5例無(wú)癌腫根治手術(shù)適應(yīng)證，但有嚴(yán)重排尿困難而選擇TURP，接受TURP術(shù)204例。204例年齡55~84歲，平均76.3±5.5歲；術(shù)前均有顯著排尿困難，國(guó)際前列腺癥狀評(píng)分15~32分，平均26.3±5.5分，因急性尿潴留而留置導(dǎo)尿管入院32例。術(shù)中出現(xiàn)水中毒癥狀6例（2.94%），年齡69~82歲，平均77.3±2.6歲，前列腺體積60~100 ml平均75.5±15.4 ml，IPSS24~32分，平均29.3±2.3分。水中毒臨床表現(xiàn)：（1）打哈欠，血壓下降，使用升壓藥效果不明顯，血?dú)夥治鍪狙t蛋白、血細(xì)胞壓積較術(shù)前下降明顯，與估計(jì)的手術(shù)出血量不相符，血鉀、血鈉低于正常；（2）患者全腹或下腹部明顯隆起，20號(hào)針頭穿刺隆起部位有大量液體溢出；（3）術(shù)中電切時(shí)前列腺包膜被切穿，或膀胱頸口切除較多使得膀胱頸與前列腺部分分離，或作膀胱穿刺經(jīng)腹膜能推知手術(shù)灌洗液大量滲入膀胱周圍或進(jìn)入腹腔內(nèi)。
1．2 手術(shù)方法 除3例患者因腰椎疾患而接受全身麻醉外，其余201例皆于腰麻下進(jìn)行手術(shù)。采用F25.5鏡鞘Storz電切鏡進(jìn)行汽化電切，常規(guī)作恥骨
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