论文部分内容阅读
目的探讨经尿道前列腺切除术后再手术的原因。方法回顾分析202例经尿道前列腺切除术的临床资料,其中再手术16例中,继发出血7例、尿道狭窄6例和前列腺癌3例,分析原因及处理对策。结果术后出血可能有腺体残留、切面不光整、前列腺创面感染、膀胱痉挛、电凝创造面焦痂脱落等引起。尿道狭窄和膀胱颈挛缩可能与术中切断膀胱颈口环形肌肉、电凝时功率过大、气囊管牵拉过度或时间过长有关。导尿管过粗,留置时间过长,拉力过大,对尿道产生压迫作用,引起尿道黏膜缺血坏死致尿道狭窄。术前常规行血清PSA检查,排除前列腺癌,术后应即行薄层病理切片检查,以尽早发现隐藏的前列腺癌。16例再手术与腺体残留、感染、膀胱颈部挛缩和导尿管压迫留置时间过长等因素有关,再次手术治愈。结论围手术期处理和熟练掌握手术操作技术是防止经尿道前列腺切除术后再手术的关键。
Objective To investigate the causes of reoperation after transurethral resection of the prostate. Methods Retrospective analysis of 202 cases of transurethral resection of the clinical data, of which 16 cases of reoperation, secondary hemorrhage in 7 cases, 6 cases of urethral stricture and 3 cases of prostate cancer, analyze the causes and treatment strategies. Results postoperative bleeding may have residual glands, not only the entire section, the prostate wound infection, bladder spasm, coagulation caused by esophageal surface scab off caused. Urethral stricture and bladder neck contracture may be associated with intraoperative resection of the bladder neck ring muscle, excessive power when electrocoagulation, balloon catheter over or over time. Catheter too thick, indwelling time is too long, too much tension, urethral oppression, causing urethral mucosal ischemia and necrosis caused by urethral stricture. Preoperative routine serum PSA test to rule out prostate cancer, thin film biopsy should be performed postoperative biopsy to detect hidden prostate cancer as soon as possible. 16 cases of reoperation and glandular residue, infection, bladder neck contracture and urinary catheter obstruction for a long time and other factors related to re-operation was cured. Conclusion Perioperative management and mastery of surgical techniques are the key to prevent reoperation after transurethral resection of prostate.