Prevention and treatment of transurethral resection syndrome（Report of 2 335 cases）
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摘要: 目的:探讨经尿道电切术(transurethral resection, TUR)所致电切综合征(TURS)的特点及防治方法。方法:回顾性分析我院1989~2010年施行的2 335例TUR所致63例TURS患者的临床资料,分析术中发生TURS的特点、与手术操作的关系及防治措施。结果:第一阶段经尿道电切手术120例中,发生TURS者14例(11.67%),均为TURP,其中死亡2例;第二阶段经尿道电切手术2 215例,发生TURS者49例(2.21%),无死亡病例。63例均出现不同的TURS症状,出现症状前可伴有血糖升高、低钠血症、中心静脉压升高以及血压波动。术中有24例出现前列腺包膜穿孔(38.1%),经利尿和补充高渗氯化钠溶液等处理后,症状均获改善。结论:TUR中发生TURS与操作技术密切相关,严密观察先兆症状及监测血糖、电解质、中心静脉压等,可较早发现TURS。低压灌注、缩短时间、彻底止血、避免损伤、利尿及纠正低钠血症是防治TURS的有效手段。Abstract: Objective:To summerize the character and the preventive therapeutic methods of transurethral resection syndrome(TURS) during transurethral resection (TUR).Method:To review the data of 2 335 patients with TUR from 1989 to 2010 and investigate 63 TURS character, relationship with operation technics and therapeutic experiences.Result:The first phase, Among 120 patients, 14 with TURP showed TURS(11.67%) and 2 died of TURS. The second phase, Among 2 215 patients, 49 showed TURS(2.21%), No patient died in second phase. 63 patients showed variant levels TURS symptom. Pre-TURS symptoms included blood glucose increased, serum sodium decreased. CVP(central venous pressure) increased and unstable blood pressure. There were 24 patients had perforation of prostate capsule(38.1%) after using diuria and sodium solution. TURS symptom improved.Conclusion:The occurrence of TURS during TUR was highly related with operation technics, keep close watch over pre-TURS symptoms, blood glucose, serum sodium and CVP, TURS can be detected early. Filling with low pressure, shortening the operation time, keeping haemostasis, avoiding damage, diuresis and correct hyponatremia could effectively prevent and treat TURS.
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