经尿道前列腺剜除术中镜下解剖应用体会.docVIP

经尿道前列腺剜除术中镜下解剖应用体会【摘要】目的 探讨经尿道前列腺剜除术（TUERP）中镜下解剖应用，总结后尿道前列腺解剖要点。方法 采用经尿道前列腺剜出术（TUERP）治疗56例前列腺增生症。观察手术时间、术中出血量、术后留置尿管时间、术中并发症及住院时间，术前、术后IPSS评分、QOL评分、RU、Qmax的差异。结果 手术时间45-150min，平均65min。术中出血量50-150ml，平均80ml。术后留置尿管时间4-7d，平均住院时间6.9d。56例患者均一次性治疗成功，无输血、膀胱穿孔及水中毒等并发症发生，其中2例后尿道穿孔，3例外科包膜穿孔。术后随访6-24月，最大尿流率较术前明显改善，术后逆行射精发生率明显降低。结论 熟练掌握镜下后尿道前列腺解剖特点，经尿道剜除前列腺时可以做到腺体切除前先断血供的外科手术基本要求，切除彻底，出血少，视野清，达到开放前列腺切除术的彻底程度。 【关键词】经尿道前列腺剜除术 前列腺增生 中图分类号：R699.8文献标识码：A文章编号：1005-0515（2011）4-007-02 【Abstract】Objective To investigate the application of endoscopic anatomy in the transurethral enucleation resection of prostate, sum up the anatomic highlight oftheposterior urethra.Methods Observe the operation time, hemorrhage volume, postoperative indwelling catheter time, intraoperative complications and hospitalization time, and the difference of preoperative and postoperative IPSS score, QOL score, RU, Qmax about 56 patient with BPH who treated with the TUERP. Results Operation time was 45-150min and the average was 65min, hemorrhage volume was 50-150ml and the average was 80ml. Indwelling catheter time was 4-7d and the average was 6.9d. 56 patient are successfully treated in one time, no blood transfusion, vesical perforation and water intoxication, there are 2 cases posterior urethral perforation and 3 cases amicula perforation. Patients were followed up for 6-24 months, maximum urinary flow rate significantly improved and the incidence of retrograde ejaculation decreased.Conclusions Applicating the anatomy of the posterior urethra skilly in TUERP, it is possible to cut off the blood supply of prostate and complete removal the prostate with less bleeding and clearer vision 【key words】Transurethral Enucleation Resection of Prostate（TUERP）Benign Prostate Hyperplasia（BPH） 随着泌尿腔内技术的发展，TURP（经尿道前列腺电切术）成为治疗BPH的金标准[1]后，近年相继有TUVP（经尿道前列腺汽化电切术）、PKVP（等离子汽化）、TUERP（经尿道前列腺剜出术）、HOLEP（经尿道激光前列腺剜出术）等腔内手术方法治疗BPH，都是为避免术中出血多、视野不清、TURS（TUR综合症）、术后尿失禁、二次手术等并发症进行的手术方法以及手术技巧、器械的改进，基础是必须熟悉术中后尿道前列腺的镜下解剖。我科2006-2