改良Madigan前列腺增生腺体摘除术.DOCVIP

临床医学论文-改良Madigan前列腺增生腺体摘除术 ??????????? 作者：朱雪阳 钟狂飚 曾青 谷志余 　【摘要】 目的? 探讨Madigan前列腺增生摘除术的改进方法。 方法? 31例前列腺增生者经改良的Madigan施行了腺体摘除术。探查并处理膀胱病变后，前列腺包膜逐一钳夹、切开、结扎，预留包膜对合线。在无血情况下游离腺体，剥离出尿道，切除前列腺腺体，将预留的包膜对合结扎，膀胱造瘘。 结果? 所有患者均顺利完成手术，术中出血少。2例手术结束时发现活动性出血，立即拆除缝线探查，发现因前列腺太大，液囊滑入前列腺窝，引起出血。充液50ml，阴茎头牵引，出血停止。1例术后未行牵引，近期出血，立即牵引，出血停止。所有拔管后排尿正常，未见远期并发症。 结论? 改良Madigan前列腺摘除术，出血少，包膜切口解剖对位好。与经典的Madigan前列腺增生腺体摘除术相比，省时。腺体在无出血的情况下切除，术后恢复更平稳、安全、可靠。???? 　　关键词? 前列腺增生 外科手术 Madigan前列腺摘除???? 　　Improved Madigan prostatectomy（report of31cases）???????? 　　【Abstract】 Objective To present and evaluate improvement of Madigan prostatectomy.Methods Resection of hyperplasia prostate had been preformed in31cases by using improved Madigan technique.Exposed and opend the blad-der，reproved or treated its diseases，and checked anatomy marks in bladder.Exposed retro pubic space，inserted a Foley catheter to bladder.Made a vertical incision on prostate capsule into the surface of adenoma，transverse incising and transfixing suture the capsule，retained capsule closed sutures，freed the prostate adenoma under no bleeding，sharping dissect the urethra，removed the adenoma，knotting retain sutures on capsule.To do cystostomy.Results All patients were performed successlly.2patients were noted bleeding when the operation finished on the table.Its suffered from the adenoma too large and the balloon fallen into the prostatic fossa.After the balloon was filled to50ml and put traction，the bleeding stop immediately.In one case the traction was not been done and had bleeding.After did that，the bleeding stop，too.All patients had good urinary stream postoperatively.No complications presented in latter stage.Conclusion The improved Madigan prostatectomy has less bleeding，incision is able to approach under anatomy，has less complica-tions.It is a more safe，and dependable method than classical Madigans.??? 　　Key words hyperplasia prostate surgery Madigan prostatectomy?????? 　　无论哪种方法的前列腺增生腺体摘除手术，均可发生严重的手术并发症 ［1］ ，包括出血、感染、尿失禁、尿道狭窄等，其中以