摘要
目的 评估改良经尿道前列腺等离子剜除术（TUPKEP）对伴有冠心病的高危良性前列腺增生（BPH）患者围手术期的安全性.方法 将128例BPH患者分为伴有冠心病组24例,其中10例行经尿道前列腺汽化电切术（TUVP）,14例行改良TUPKEP;不伴有冠心病组104例,22例行TUVP,82例行改良TUPKEP.分别于术前2h及术后1、2和6d采用特异性放射免疫法检测血清内皮素（ET）-1,并观察并发症情况.结果 所有患者均完成手术治疗并顺利出院.伴有冠心病组和不伴有冠心病组TUVP患者与改良TUPKEP患者术前2h血清ET-1比较差异无统计学意义（P＞0.05）;TUVP患者术后1和2d血清ET-1明显高于改良TUPKEP患者[伴有冠心病组：（114.09±15.33） ng/L比（94.77±12.14） ng/L和（99.67±9.87） ng/L比（88.21±9.55） ng/L;不伴有冠心病组：（70.21±12.44） ng/L比（53.67±9.02） ng/L和（61.18±9.52） ng/L比（48.54 ±9.15） ng/L],差异有统计学意义（P＜ 0.05）;TUVP患者与改良TURKEP患者术后6d血清ET-1比较差异无统计学意义（P＞0.05）.伴有冠心病组5例于术后早期出现缺血性ST-T改变,3例发生心绞痛,均经及时处理病情得以控制,未发生急性心肌梗死、急性心力衰竭及心源性猝死等严重并发症.结论 BPH患者术后普遍存在有血管内皮损伤,伴有冠心病的高危患者尤甚,其可能为术后发生心血管不良事件的原因之一.相对于TUVP,改良TUPKEP对血管内皮功能的影响较轻,从而减少伴有冠心病的高危BPH患者术后发生心血管不良事件的概率,是一种更为安全的手术方法.
Objective To evaluate the perioperative period safety of improved transurethral plasma kinetic enucleation of prostate （TUPKEP） in high-risk benign prostatic hyperplasia （BPH） patients with coronary heart disease （CHD）.Methods One hundred and twenty-eight BPH patients were selected,24 patients had CHD （with CHD group）,among whom 10 patients were given transurethral vapor-resection of prostate （TUVP）,and 14 patients were given improved TUPKEP; 104 patients didn＇t have CHD,among whom 22 patients were given TUVP,and 82 patients were given improved TUPKEP.The serum endothelin （ET）-1 was measured by specific radioimmunoassay at preoperative 2 h and postoperative 1,2,6 d,and complication was observed.Results All the patients were cured by operation,and left hospital smoothly.There were no statistical differences in the preoperative 2 h serum ET-1 in with CHD group and without CHD group （including all TUVP patients and improved TUPKEP patients） （P 〉 0.05）.The postoperative 1 and 2 d serum ET-1 levels of TUVP patients were significantly higher than those of improved TUPKEP patients,in with CHD group：（114.09 ± 15.33） ng/L vs.（94.77 ± 12.14） ng/L and （99.67 ± 9.87） ng/L vs.（88.21 ± 9.55） ng/L; in without CHD group：（70.21 ± 12.44） ng/L vs.（53.67 ± 9.02） ng/L and （61.18 ± 9.52） ng/L vs.（48.54 ± 9.15） ng/L,and there were statistical differences （P 〈 0.05）.There were no statistical differences in postoperative 6 d serum ET-1 in TUVP patients and improved TURKEP patients （P 〉 0.05）.In with CHD group,5 patients had ischemic ST-T change in the early postoperative period,and 3 patients had angina pectoris.They all were promptly treated,and the events were controlled.Serious complications did not present such as acute myocardial infarction （AMI）,acute heart failure and sudden cardiac death,etc.Conclusions The postoperative BPH patients have vascular endothelial injury catholically,especially the high-risk patients with CHD.Furthermore,it
出处
《中国医师进修杂志》
2015年第3期167-170,共4页
Chinese Journal of Postgraduates of Medicine
