临床误诊误治
臨床誤診誤治
림상오진오치
CLINICAL MISDIAGNOSIS & MISTHERAPY
2014年
7期
93-95
,共3页
经尿道前列腺切除术%并发症%膀胱疾病%原因分析
經尿道前列腺切除術%併髮癥%膀胱疾病%原因分析
경뇨도전렬선절제술%병발증%방광질병%원인분석
Transurethral resection of prostate%Complication%Bladder disease%Cause analysis
目的：探讨经尿道等离子体双极前列腺电切术（transurethral plasmakinetic resection of prostate,PKRP)后早期出血致膀胱填塞的原因。方法回顾分析我院2005年1月—2012年1月35例 PKRP 术后24 h 内出血致膀胱填塞患者的临床资料。结果本组常规行 PKRP,术中均顺利,膀胱填塞发生于术后6 h 内28例,6~12 h 内7例。19例表现为下腹部剧痛,冲洗液鲜红或伴随冲洗液反流；16例无主诉,仅表现为冲洗液反流或停止或波动样流动。35例经 B 超检查明确膀胱填塞,重返手术室酌情采取镜下冲洗血凝块、电凝止血,或电切血凝块,或电切残留小腺体并电凝止血等处理,5 d 后出院。随访2~7年,排尿正常,无再次出血。结论膀胱痉挛是 PKRP 术后24 h 内出血致膀胱填塞的高危因素,尤其对下腹部无明显疼痛的膀胱痉挛患者,要善于观察,并及早行 B 超检查,避免延误诊断与处理。
目的：探討經尿道等離子體雙極前列腺電切術（transurethral plasmakinetic resection of prostate,PKRP)後早期齣血緻膀胱填塞的原因。方法迴顧分析我院2005年1月—2012年1月35例 PKRP 術後24 h 內齣血緻膀胱填塞患者的臨床資料。結果本組常規行 PKRP,術中均順利,膀胱填塞髮生于術後6 h 內28例,6~12 h 內7例。19例錶現為下腹部劇痛,遲洗液鮮紅或伴隨遲洗液反流；16例無主訴,僅錶現為遲洗液反流或停止或波動樣流動。35例經 B 超檢查明確膀胱填塞,重返手術室酌情採取鏡下遲洗血凝塊、電凝止血,或電切血凝塊,或電切殘留小腺體併電凝止血等處理,5 d 後齣院。隨訪2~7年,排尿正常,無再次齣血。結論膀胱痙攣是 PKRP 術後24 h 內齣血緻膀胱填塞的高危因素,尤其對下腹部無明顯疼痛的膀胱痙攣患者,要善于觀察,併及早行 B 超檢查,避免延誤診斷與處理。
목적：탐토경뇨도등리자체쌍겁전렬선전절술（transurethral plasmakinetic resection of prostate,PKRP)후조기출혈치방광전새적원인。방법회고분석아원2005년1월—2012년1월35례 PKRP 술후24 h 내출혈치방광전새환자적림상자료。결과본조상규행 PKRP,술중균순리,방광전새발생우술후6 h 내28례,6~12 h 내7례。19례표현위하복부극통,충세액선홍혹반수충세액반류；16례무주소,부표현위충세액반류혹정지혹파동양류동。35례경 B 초검사명학방광전새,중반수술실작정채취경하충세혈응괴、전응지혈,혹전절혈응괴,혹전절잔류소선체병전응지혈등처리,5 d 후출원。수방2~7년,배뇨정상,무재차출혈。결론방광경련시 PKRP 술후24 h 내출혈치방광전새적고위인소,우기대하복부무명현동통적방광경련환자,요선우관찰,병급조행 B 초검사,피면연오진단여처리。
Objective To explore the causes of bladder tamponade induced by early bleeding after transurethral plas-makinetic resection of prostate (PKRP). Methods Clinical data of 35 patients with bladder tamponade induced by early bleeding within 24 h after PKRP during January 2005 and January 2012 was retrospectively analyzed. Results All the pa-tients underwent routine PKRP of successful operation process, 28 patients had bladder tamponade within 6 h after the opera-tion, and 7 patients had bladder tamponade within 6 - 12 h after the operation, 19 patients suffered severe pain in lower abdo-men, bright red washing fluid or contraflow with washing fluid; 16 patients did not complain with contraflow, stopping or wave-like movement of washing fluid. All the 35 patients were confirmed with having the bladder tamponade by B ultrasound exami-nation, and underwent washing the blood clot under the microscope, electric coagulation hemostasis, transurethral clot or tran-surethral residual small glands electric coagulation treatment accordingly, and then were discharged 5 d after the treatment. No one patient had bleeding with normosthenuria with 2 - 7 years of follow-up. Conclusion Cystospasm is the high risk factor of bladder tamponade induced by early bleeding within 24 h after transurethral plasmakinetic resection of prostate, so clinicians should pay more attention especially to patients without obvious abdomen pain of cystospasm, and perform the B-mode ultra-sonography to avoid delay in diagnosis and treatment.
