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·腹部疾病·

经尿道2μm激光前列腺汽化切除术后再入院原因及对策*

作者:陈宇东1 张军勇1 韩 刚1 刘伟英1 王领军1 张 倩1 王志鹏1 王 强1 史建国1 高江平2 王晓雄2 张 旭2

所属单位:1.解放军252医院泌尿外科 (河北 保定 071000) 2.解放军总医院泌尿外科 (北京 100853)

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摘要

目的 探讨经尿道RevoLix 2μm激光前列腺汽化切除术后需再次入院治疗的原因。方法 回顾性分析2011年6月至 2014年6月本院收治的经尿道2μm激光前列腺汽化切除术后再入院患者的临床资料。结果 317例接受经尿道2μm激 光前列腺汽化切除术患者再次入院16例。再入院原因按发生例数依次排列如下:血尿8例,膀胱颈挛缩3例,前列腺 癌2例,前尿道狭窄、泌尿系感染和急性附睾炎各1例。给予相应处理后均顺利出院。结论 继发出血及膀胱颈挛缩 是经2μm激光前列腺汽化切除术后再入院的主要原因,需注意围术期管理及术后随访,根据病情变化及时给予相应 处理。

Objective To analyze the causes and managents of readmission after transurethral vaporesection for benign prostatic hyperplasia by 2μm continuous wave laser. Methods A retrospective study was conducted to summarize the cases who were readmitted after transurethral vaporesection for BPH by 2μm continuous wave laser. Results 317 patients received this operation from June 2011 to June 2014 in our hospital. Among them, 16 patients experienced readmission after mean interval of 1.8 months with an incidence rate of 5.05%. 8 cases that had experienced bleeding and acute retention underwent transurethral bladder washing and coagulating. Bladder neck contracture was found in 3 cases and received transurethral resection of scar by 2μm continuous wave laser, followed with regular urethral dilatation. Prostate cancer was detected in 2 cases, who received medical castration finally. 1 cases developed anterior urethral stricture and received internal urethrotomy by 2μm continuous wave laser and followed with regular urethral dilatation. 2 case received antibiotic therapy for urological tract infection or unilateral acute epididymitis. Conclusions Bleeding and bladder neck contracture were main causes for readmission after this operation. Correct preoperative diagnosis, rational surgical type and adequate intraoperative and postoperative management are keys to preventing readmission.

【关键词】良性前列腺增生;经尿道前列腺切除术;激光手术; 再次入院

【中图分类号】R697.3;R454.2

【文献标识码】A

【DOI】10.3969/j.issn.1009-3257.2016.01.012

前言

经尿道2μm激光前列腺汽化切除术是目前治疗前 列腺增生的最新的微创手术方法,具有操作精细、出 血少、恢复快、并发症少等优点[1-2]。但部分患者因 术后并发症等原因需再次入院治疗[3],分析其再入院 的原因对预防和正确处理至关重要。我院自2011年6 月至2014年6月采用经尿道2μm激光前列腺汽化切除术治疗BPH患者317例,其中16例患者出院后1.8(0.6- 25.3)月再次入院。本文旨在对上述患者再入院原因 和处理措施进行探讨,报告如下。