【關鍵詞】 良性前列腺增生；經尿道前列腺汽化電切術；水中毒
The prevention and treatment of overhydration in TURP cases
[Abstract] Objective: To study the prevention and treatment of overhydration in transurethral prostatic resection (TURP) patients. Methods: 6 cases of diagnosing and treating overhydration were analysed. The average age is (77.3±2.6) yrs (69~82yrs), the average volume of prostate was (75.5±15.4) ml (60~100ml), and the international prostatic symptom score was (29.3±2.3) (24~32). The water toxic symptoms began within (35~75min)average (45.3±12.5) min after operation, and the therapeutic measures having been used included: (1) 20% mannitol for anhydration and diuresis; (2)supplying hyperosmosis natrium; (3)correcting hypotension and acidosis; (4)puncturing and draining hydrops of abdominal cavity or prevesical space; (5)stopping or suspending operation immediately. Results: All patients' vital signs turned to stable after treatment, no more severe complications occurred, and the follow-up 1 month after operation showed urinating smoothly. Conclusions: As a golden standard of BPH surgical treatment, the application of TURP may decrease patients' injury, cut down the cost of hospitalization, shorten the length of stay and increase the therapeutic efficacy. If proper protective measures are taken and early diagnosis and early treatment are given for those overhydration patients, the TURP method will be safer and more reliable.
[Key words] Benign prostatic hypertrophy; Transurethral prostatectomy; Overhydration
良性前列腺增生（BPH）患者採用經尿道前列腺電切或汽化電切術（transurethral prostatectomy，TURP）治療。該術式優點為創傷微小、失血量少、住院時間短、住院費用低等。目前它已取代絕大多數開放手術，成為多數中等以上醫院泌尿外科醫師的首選治療方案。但TURP式術中易出現水中毒，即電切過程中大量水分進入迴圈系統，導致稀釋性低鈉血癥與心力衰竭。如預防與處理不當，可造成嚴重後果甚至死亡[1，2]。我院2005年12月~2006年12月對204例患者施行TURP手術，其中6例發生水中毒，經緊急處理後取得滿意療效。
1 臨床資料
1．1 一般資料 收治良性前列腺增生202例，因各種原因採用經恥骨上經膀胱摘除手術3例，經尿道前列腺電切或汽化電切術199例；前列腺癌5例無癌腫根治手術適應證，但有嚴重排尿困難而選擇TURP，接受TURP術204例。204例年齡55~84歲，平均76.3±5.5歲；術前均有顯著排尿困難，國際前列腺症狀評分15~32分，平均26.3±5.5分，因急性尿瀦留而留置導尿管入院32例。術中出現水中毒症狀6例（2.94%），年齡69~82歲，平均77.3±2.6歲，前列腺體積60~100 ml平均75.5±15.4 ml，IPSS24~32分，平均29.3±2.3分。水中毒臨床表現：（1）打哈欠，血壓下降，使用升壓藥效果不明顯，血氣分析示血紅蛋白、血細胞壓積較術前下降明顯，與估計的手術出血量不相符，血鉀、血鈉低於正常；（2）患者全腹或下腹部明顯隆起，20號針頭穿刺隆起部位有大量液體溢位；（3）術中電切時前列腺包膜被切穿，或膀胱頸口切除較多使得膀胱頸與前列腺部分分離，或作膀胱穿刺經腹膜能推知手術灌洗液大量滲入膀胱周圍或進入腹腔內。