中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2015年
3期
167-170
,共4页
孟庆超%李静梅%仇让学%李明峰%卢喜伟
孟慶超%李靜梅%仇讓學%李明峰%盧喜偉
맹경초%리정매%구양학%리명봉%로희위
经尿道前列腺切除术%前列腺增生%内皮缩血管肽1%经尿道前列腺等离子剜除术
經尿道前列腺切除術%前列腺增生%內皮縮血管肽1%經尿道前列腺等離子剜除術
경뇨도전렬선절제술%전렬선증생%내피축혈관태1%경뇨도전렬선등리자완제술
Transurethral resection of prostate%Prostatic hyperplasia%Endothelin-1%Transurethral plasma kineticenuc leation of prostate
目的 评估改良经尿道前列腺等离子剜除术(TUPKEP)对伴有冠心病的高危良性前列腺增生(BPH)患者围手术期的安全性.方法 将128例BPH患者分为伴有冠心病组24例,其中10例行经尿道前列腺汽化电切术(TUVP),14例行改良TUPKEP;不伴有冠心病组104例,22例行TUVP,82例行改良TUPKEP.分别于术前2h及术后1、2和6d采用特异性放射免疫法检测血清内皮素(ET)-1,并观察并发症情况.结果 所有患者均完成手术治疗并顺利出院.伴有冠心病组和不伴有冠心病组TUVP患者与改良TUPKEP患者术前2h血清ET-1比较差异无统计学意义(P＞0.05);TUVP患者术后1和2d血清ET-1明显高于改良TUPKEP患者[伴有冠心病组:(114.09±15.33) ng/L比(94.77±12.14) ng/L和(99.67±9.87) ng/L比(88.21±9.55) ng/L;不伴有冠心病组:(70.21±12.44) ng/L比(53.67±9.02) ng/L和(61.18±9.52) ng/L比(48.54 ±9.15) ng/L],差异有统计学意义(P＜ 0.05);TUVP患者与改良TURKEP患者术后6d血清ET-1比较差异无统计学意义(P＞0.05).伴有冠心病组5例于术后早期出现缺血性ST-T改变,3例发生心绞痛,均经及时处理病情得以控制,未发生急性心肌梗死、急性心力衰竭及心源性猝死等严重并发症.结论 BPH患者术后普遍存在有血管内皮损伤,伴有冠心病的高危患者尤甚,其可能为术后发生心血管不良事件的原因之一.相对于TUVP,改良TUPKEP对血管内皮功能的影响较轻,从而减少伴有冠心病的高危BPH患者术后发生心血管不良事件的概率,是一种更为安全的手术方法.
目的 評估改良經尿道前列腺等離子剜除術(TUPKEP)對伴有冠心病的高危良性前列腺增生(BPH)患者圍手術期的安全性.方法 將128例BPH患者分為伴有冠心病組24例,其中10例行經尿道前列腺汽化電切術(TUVP),14例行改良TUPKEP;不伴有冠心病組104例,22例行TUVP,82例行改良TUPKEP.分彆于術前2h及術後1、2和6d採用特異性放射免疫法檢測血清內皮素(ET)-1,併觀察併髮癥情況.結果 所有患者均完成手術治療併順利齣院.伴有冠心病組和不伴有冠心病組TUVP患者與改良TUPKEP患者術前2h血清ET-1比較差異無統計學意義(P＞0.05);TUVP患者術後1和2d血清ET-1明顯高于改良TUPKEP患者[伴有冠心病組:(114.09±15.33) ng/L比(94.77±12.14) ng/L和(99.67±9.87) ng/L比(88.21±9.55) ng/L;不伴有冠心病組:(70.21±12.44) ng/L比(53.67±9.02) ng/L和(61.18±9.52) ng/L比(48.54 ±9.15) ng/L],差異有統計學意義(P＜ 0.05);TUVP患者與改良TURKEP患者術後6d血清ET-1比較差異無統計學意義(P＞0.05).伴有冠心病組5例于術後早期齣現缺血性ST-T改變,3例髮生心絞痛,均經及時處理病情得以控製,未髮生急性心肌梗死、急性心力衰竭及心源性猝死等嚴重併髮癥.結論 BPH患者術後普遍存在有血管內皮損傷,伴有冠心病的高危患者尤甚,其可能為術後髮生心血管不良事件的原因之一.相對于TUVP,改良TUPKEP對血管內皮功能的影響較輕,從而減少伴有冠心病的高危BPH患者術後髮生心血管不良事件的概率,是一種更為安全的手術方法.
목적 평고개량경뇨도전렬선등리자완제술(TUPKEP)대반유관심병적고위량성전렬선증생(BPH)환자위수술기적안전성.방법 장128례BPH환자분위반유관심병조24례,기중10례행경뇨도전렬선기화전절술(TUVP),14례행개량TUPKEP;불반유관심병조104례,22례행TUVP,82례행개량TUPKEP.분별우술전2h급술후1、2화6d채용특이성방사면역법검측혈청내피소(ET)-1,병관찰병발증정황.결과 소유환자균완성수술치료병순리출원.반유관심병조화불반유관심병조TUVP환자여개량TUPKEP환자술전2h혈청ET-1비교차이무통계학의의(P＞0.05);TUVP환자술후1화2d혈청ET-1명현고우개량TUPKEP환자[반유관심병조:(114.09±15.33) ng/L비(94.77±12.14) ng/L화(99.67±9.87) ng/L비(88.21±9.55) ng/L;불반유관심병조:(70.21±12.44) ng/L비(53.67±9.02) ng/L화(61.18±9.52) ng/L비(48.54 ±9.15) ng/L],차이유통계학의의(P＜ 0.05);TUVP환자여개량TURKEP환자술후6d혈청ET-1비교차이무통계학의의(P＞0.05).반유관심병조5례우술후조기출현결혈성ST-T개변,3례발생심교통,균경급시처리병정득이공제,미발생급성심기경사、급성심력쇠갈급심원성졸사등엄중병발증.결론 BPH환자술후보편존재유혈관내피손상,반유관심병적고위환자우심,기가능위술후발생심혈관불량사건적원인지일.상대우TUVP,개량TUPKEP대혈관내피공능적영향교경,종이감소반유관심병적고위BPH환자술후발생심혈관불량사건적개솔,시일충경위안전적수술방법.
Objective To evaluate the perioperative period safety of improved transurethral plasma kinetic enucleation of prostate (TUPKEP) in high-risk benign prostatic hyperplasia (BPH) patients with coronary heart disease (CHD).Methods One hundred and twenty-eight BPH patients were selected,24 patients had CHD (with CHD group),among whom 10 patients were given transurethral vapor-resection of prostate (TUVP),and 14 patients were given improved TUPKEP; 104 patients didn't have CHD,among whom 22 patients were given TUVP,and 82 patients were given improved TUPKEP.The serum endothelin (ET)-1 was measured by specific radioimmunoassay at preoperative 2 h and postoperative 1,2,6 d,and complication was observed.Results All the patients were cured by operation,and left hospital smoothly.There were no statistical differences in the preoperative 2 h serum ET-1 in with CHD group and without CHD group (including all TUVP patients and improved TUPKEP patients) (P ＞ 0.05).The postoperative 1 and 2 d serum ET-1 levels of TUVP patients were significantly higher than those of improved TUPKEP patients,in with CHD group:(114.09 ± 15.33) ng/L vs.(94.77 ± 12.14) ng/L and (99.67 ± 9.87) ng/L vs.(88.21 ± 9.55) ng/L; in without CHD group:(70.21 ± 12.44) ng/L vs.(53.67 ± 9.02) ng/L and (61.18 ± 9.52) ng/L vs.(48.54 ± 9.15) ng/L,and there were statistical differences (P ＜ 0.05).There were no statistical differences in postoperative 6 d serum ET-1 in TUVP patients and improved TURKEP patients (P ＞ 0.05).In with CHD group,5 patients had ischemic ST-T change in the early postoperative period,and 3 patients had angina pectoris.They all were promptly treated,and the events were controlled.Serious complications did not present such as acute myocardial infarction (AMI),acute heart failure and sudden cardiac death,etc.Conclusions The postoperative BPH patients have vascular endothelial injury catholically,especially the high-risk patients with CHD.Furthermore,it might be one of the causes of the postoperative adverse cardiovascular events.Compared with TUVP,improved TUPKEP has a minor impact on vascular endothelial function,and it can reduce the postoperative adverse cardiovascular events in the BPH patients with CHD.Improved TUPKEP is a relatively safer surgical method for high-risk BPH with CHD.
