CAJ | 학술논문

目的：探讨经尿道等离子前列腺电切术（TUPKP）后出血的原因及处理措施。方法2006年9月至2012年9月在新沂市人民医院及南京医科大学第二附属医院，共有362例前列腺增生患者施行TUPKP，回顾性分析其中26例术后继发膀胱大出血，分别经加强膀胱冲洗，充分引流，电切镜下冲洗血凝块并电凝止血及转开放膀胱切开清除血块的止血处理等处理，评价这部分患者的出血原因及处理效果。结果26例继发膀胱大出血，其中术后早期出血23例，迟发性出血3例；17例经加强冲洗，充分引流，保守治疗治愈，8例于电切镜下冲洗血凝块并电凝止血出血点后好转，其中1例再次复发出血，行2次镜下冲洗血凝块，1例开放膀胱切开手术清除血块处理。出血易发生在高龄、高血压、糖尿病、凝血障碍等患者，也与术中止血不充分及术后管理的失当有关。结论术前完善相关检查、术中确切止血及术后管理是预防TURKP术后出血的关键；术后及时发现出血并正确处理可避免再次手术，对患者术后恢复有着重要意义。
목적：탐토경뇨도등리자전렬선전절술（TUPKP）후출혈적원인급처리조시。방법2006년9월지2012년9월재신기시인민의원급남경의과대학제이부속의원，공유362례전렬선증생환자시행TUPKP，회고성분석기중26례술후계발방광대출혈，분별경가강방광충세，충분인류，전절경하충세혈응괴병전응지혈급전개방방광절개청제혈괴적지혈처리등처리，평개저부분환자적출혈원인급처리효과。결과26례계발방광대출혈，기중술후조기출혈23례，지발성출혈3례；17례경가강충세，충분인류，보수치료치유，8례우전절경하충세혈응괴병전응지혈출혈점후호전，기중1례재차복발출혈，행2차경하충세혈응괴，1례개방방광절개수술청제혈괴처리。출혈역발생재고령、고혈압、당뇨병、응혈장애등환자，야여술중지혈불충분급술후관리적실당유관。결론술전완선상관검사、술중학절지혈급술후관리시예방TURKP술후출혈적관건；술후급시발현출혈병정학처리가피면재차수술，대환자술후회복유착중요의의。
Objective To investigate the causes and countermeasures for postoperative massive bleeding of BPH patients accepted transurethral plasma kinetic resection of prostate (TUPKP). Methods From 2006.09 to 2012.09 in people’s hospital of Xinyi city, 362 patients with BPH accepted TUPKP, and 26 cases of postoperative massive bleeding occurred. A retrospective study was performed to evaluate the causes and countermeasures, including strengthen bladder irrigation, adequate drainage, conservative treatment, washing of blood clots in transurethral endoscopic, coagulation and open surgical removal of blood clots. Results Among these bleeding cases, 23 cases occurred in the early postoperative stage and the rest were delayed bleeding. 17 patients were cured via strengthen washing and adequate drainage, 8 cases accepted washing of blood clots in transurethral endoscopic and coagulation including one case with recurrent bleeding, open surgical removal of blood clots was performed on one patient. The causes of postoperative massive bleeding include age, hypertension, diabetes and coagulation disorders. Meanwhile, inadequate intraoperative hemostasis and misconduct of postoperative management were also associated with such bleeding. Conclusions Complete preoperative examination, exact intraoperative hemostasis and postoperative management play key roles in the prevention of postoperative bleeding after TURKP. Postoperative bleeding should be detected and treated in time, and reoperations could be prevented, which is greatly meaning for the patients’ postoperative recovery.