TURP术后腺体增生复发反复肉眼血尿者的再次手术方法探讨

摘要

Objective To investigate the surgical method of recurrence of prostatic hyperplasia patients with gross hematuria after the transurethral resection of the prostate (TURP). Methods From 2000 to 2011, we retrospec-tively analyzed 19 cases of postoperative TURP recurrence of prostatic hyperplasia due to repeated hematuria accepted operation clinical materials and follow-up results. There was a mean of 48.6 months intervals for the last TURP. 9 (47.3%) patients with diabetes mellitus, 8 (42.1%) cases with taking oral antithrombotic drugs (aspirin), and 6 (31.6%) cases with positive urine bacterial culture. Median follow-up was 46.6 months. Of the 18 (94.7%) patients were avail-able for follow-up. Results 9 cases were performed repeat TURP, and 10 cases underwent open prostatectomy. These conditions were not significantly different between TURP and open groups, including reoperative International Prostate Symptom Score (IPSS), prostate volume and postoperative IPSS score, maximum urinary flow rate (Qmax), re-sidual urine. However, 7 patients sustained regular urine oral non-finasteride at the end of the follow-up, and 6 (66.7%) cases of patients were underwent open prostatectomy. Common open operation specimens were ranged in size from nodular hyperplasia. Conclusion Gross hematuria is one of the main causes for accepting reoperation after TURP, and open operation provides improvement over TURP for reoperation.%目的：探讨反复肉眼血尿者经尿道前列腺电切术(TURP)后腺体增生复发的适宜手术方法。方法回顾性分析2000年8月至2011年8月间收治的19例TURP术后因腺体增生复发反复肉眼血尿接受再手术患者的临床资料与随访结果。结果与上次TURP时间间隔平均48.6个月。合并糖尿病9例(47.4%)；口服抗栓药（阿司匹林等）8例(42.1%)；常规尿培养细菌阳性6例(31.6%)。18例(94.7%)获完全性随访，平均46.6个月。9例行再次TURP，10例行开放性前列腺摘除术。术前国际前列腺症状评分(IPSS)、前列腺体积与术后IPSS评分、最大尿流率(Qmax)、残余尿比较，两种术式的差异均无统计学意义(P>0.05)，但是末次随访时有7例患者持续口服非那雄胺，仍会有经常性尿隐血，其中6例为再次TURP手术患者，占66.7%(6/9)。开放手术标本的共同点是均为大小不等的结节样的腺体增生。结论糖尿病、炎症感染、结石刺激、口服抗栓药等是TURP术后腺体增生复发患者反复肉眼血尿的相关因素。对失去药物治疗耐心以及血尿严重的腺体增生复发患者应考虑再手术治疗。从随访结果看开放性前列腺摘除术的效果优于再次TURP者。