目的探讨前列腺增生（BPH）合并膀胱结石同期手术的临床疗效及安全性。方法采用电切镜电切环将结石钩出、气压弹道碎石、小切口膀胱切开取石3种方法治疗膀胱结石,而后采用经尿道前列腺电切术（TURP）治疗BPH并膀胱结石51例。结果效果良...目的探讨前列腺增生（BPH）合并膀胱结石同期手术的临床疗效及安全性。方法采用电切镜电切环将结石钩出、气压弹道碎石、小切口膀胱切开取石3种方法治疗膀胱结石,而后采用经尿道前列腺电切术（TURP）治疗BPH并膀胱结石51例。结果效果良好,切口Ⅰ期愈合、无切口感染、尿漏、尿失禁等并发症,但有4例尿道外口狭窄经行尿道扩张治愈。随访6个月~5年,所有患者排尿通畅,术后最大尿流率〉15 m l,残余尿量〈20 m l,国际前列腺症状评分0~8分,无膀胱结石复发。结论 BPH合并膀胱结石同期手术的治疗：对于膀胱小结石可行电切镜电切环直接将结石钩出;对较大结石行腔内气压弹道碎石;而对大结石或多发性结石从手术时间及安全性来考虑,行小切口膀胱切开取石。根据结石大小及多发情况分别行以上3种方法治疗膀胱结石,而后行TURP,方法简单、创伤小、恢复快、效果确切、安全,值得临床推广应用。展开更多
Objective: To estimate whether rates of bladder perforation decrease with increasing surgical experience. METHODS: We performed a review of all patients undergoing a tension-free vaginal tape procedure performed by se...Objective: To estimate whether rates of bladder perforation decrease with increasing surgical experience. METHODS: We performed a review of all patients undergoing a tension-free vaginal tape procedure performed by senior resident physicians under the guidance of a single surgeon. Physician experience was assessed by sequentially assigning case numbers to each procedure for each resident. For analysis of learning curve, cases were grouped in fives (ie, first five representing cases 1 to 5, second five cases 6 to 10). RESULTS: Twenty-three residents performed 278 procedures. The median number of cases performed was 13 (range 3-22); mean number was 12.1 (sd = ±5.6). The rate of perforation was 34.2%(95/278, 95%confidence interval 28.8-39.9%). Age and weight were significantly associated with perforation. The cystotomy group was, on average 4.5 years younger (P = .007) and 7.86 kg (17.3 lb) lighter (P < .001). Rate of injury in the first five series was 40.9%, 30.7%in second series of five, and 25.9%in the third series of five and was statistically significant (linear-by-linear association χ2 = 4.286, df = 1, P = .038). The relationship between the incidence of cystotomy and the cumulative number of cases performed was inversely correlated. As the number of cases a resident completed increased, there was a slight tendency for cystotomy to decrease (P = .033). On cystoscopic examination, residents missed 35 of the 95 injuries (37%, 95%confidence interval 27.8-46.9%). CONCLUSION: A learning curve exists for tension-free vaginal tape procedures. Many injuries are missed on initial resident cystoscopic inspection, highlighting the need for comprehensive cystoscopic training during residency.展开更多
文摘目的探讨前列腺增生（BPH）合并膀胱结石同期手术的临床疗效及安全性。方法采用电切镜电切环将结石钩出、气压弹道碎石、小切口膀胱切开取石3种方法治疗膀胱结石,而后采用经尿道前列腺电切术（TURP）治疗BPH并膀胱结石51例。结果效果良好,切口Ⅰ期愈合、无切口感染、尿漏、尿失禁等并发症,但有4例尿道外口狭窄经行尿道扩张治愈。随访6个月~5年,所有患者排尿通畅,术后最大尿流率〉15 m l,残余尿量〈20 m l,国际前列腺症状评分0~8分,无膀胱结石复发。结论 BPH合并膀胱结石同期手术的治疗：对于膀胱小结石可行电切镜电切环直接将结石钩出;对较大结石行腔内气压弹道碎石;而对大结石或多发性结石从手术时间及安全性来考虑,行小切口膀胱切开取石。根据结石大小及多发情况分别行以上3种方法治疗膀胱结石,而后行TURP,方法简单、创伤小、恢复快、效果确切、安全,值得临床推广应用。
文摘Objective: To estimate whether rates of bladder perforation decrease with increasing surgical experience. METHODS: We performed a review of all patients undergoing a tension-free vaginal tape procedure performed by senior resident physicians under the guidance of a single surgeon. Physician experience was assessed by sequentially assigning case numbers to each procedure for each resident. For analysis of learning curve, cases were grouped in fives (ie, first five representing cases 1 to 5, second five cases 6 to 10). RESULTS: Twenty-three residents performed 278 procedures. The median number of cases performed was 13 (range 3-22); mean number was 12.1 (sd = ±5.6). The rate of perforation was 34.2%(95/278, 95%confidence interval 28.8-39.9%). Age and weight were significantly associated with perforation. The cystotomy group was, on average 4.5 years younger (P = .007) and 7.86 kg (17.3 lb) lighter (P < .001). Rate of injury in the first five series was 40.9%, 30.7%in second series of five, and 25.9%in the third series of five and was statistically significant (linear-by-linear association χ2 = 4.286, df = 1, P = .038). The relationship between the incidence of cystotomy and the cumulative number of cases performed was inversely correlated. As the number of cases a resident completed increased, there was a slight tendency for cystotomy to decrease (P = .033). On cystoscopic examination, residents missed 35 of the 95 injuries (37%, 95%confidence interval 27.8-46.9%). CONCLUSION: A learning curve exists for tension-free vaginal tape procedures. Many injuries are missed on initial resident cystoscopic inspection, highlighting the need for comprehensive cystoscopic training during residency.
