本文關(guān)鍵詞： 前列腺增生(BPH) HoLEP TURP 血栓栓塞　出處：《浙江大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:通過回顧性統(tǒng)計分析,初步了解TURP及HoLEP圍手術(shù)期出現(xiàn)血栓栓塞的概率。進一步通過檢測手術(shù)患者血液中反應(yīng)全身促凝和抗凝,纖溶和抗纖溶指標,以及凝血功能常規(guī)檢查,前瞻性縱向觀察和橫向比較經(jīng)尿道前列腺電切術(shù)(Transurethral Resection Of The Prostate,TURP)和經(jīng)尿道前列腺鈥激光剜除術(shù)(Holmium Laser Enucleation Of The Prostate,HoLEP)對良性前列腺增生患者(Benignprostatic hyperplasia,BPH)圍手術(shù)期血栓栓塞風險的影響。方法:(1)回顧性統(tǒng)計并分析自2013年1月至2017年3月在我院泌尿外科行TURP和HoLEP的患者病歷資料,比較兩組患者術(shù)后出現(xiàn)血栓相關(guān)性事件的比例。(2)選擇特定醫(yī)療組2015年6月至2017年3月期間收治的70例良性前列腺增生患者,隨機分為TURP組和HoLEP組,其中TURP組35例,HoLEP組35例。對于入組的患者進行詳細的病史記錄以及系統(tǒng)的體格檢查和�？企w檢,完善前列腺B超,前列腺特異抗原(PSA)測定等術(shù)前檢查,以及手術(shù)前的常規(guī)檢查。研究指標測定:在手術(shù)開始前,術(shù)后第1天,術(shù)后第3天分別檢測患者的凝血四項:活化部分凝血活酶時間(APTT),凝血酶原時間(PT),纖維蛋白原(FIB),凝血酶時間(TT),凝血酶原片段F 1+2和凝血酶-抗凝血酶復(fù)合物TAT,纖溶酶原激活物抑制劑PAI-1和組織纖溶酶原激活劑t-PA。術(shù)后觀察與隨訪:術(shù)后14天行雙下肢深靜脈彩超檢查,觀察和記錄患者術(shù)后并發(fā)癥,并在術(shù)后1月對患者進行常規(guī)隨訪。結(jié)果:(1)2013年1月至2017年3月期間在我院行TURP術(shù)的患者有448例,其中3例發(fā)生了下肢靜脈血栓伴肺梗塞,1例僅出現(xiàn)肺梗塞;行HoLEP術(shù)的患者有426例,其中1例發(fā)生了下肢靜脈血栓,未出現(xiàn)肺梗塞患者。(2)70例患者中TURP組3例既往有腦�；蚰X血管疾病史,HoLEP組2例有心梗病史,其余既往均無心腦血管和靜脈血栓或肺栓塞史,無凝血障礙,未使用抗血小板或者抗凝藥物,前列腺特異抗原(PSA)測定處于正常范圍,最終納入有效病例65例,其中行TURP的 32 例,行 HoLEP 的 33 例。HoLEP 組、TURP 組術(shù)前,F 1+2 和 TAT,PAI-1和t-PA及凝血四項比較,組間均無顯著性差異(P0.05);術(shù)后第1天,PT、APTT、TT、FIB、F1+2、TAT、t-PA 組間無顯著性差異(P0.05),TURP 組 PAI-1 高于HoLEP組,存在顯著性差異(P0.05),TURP組及HoLEP組PT較術(shù)前升高,存在顯著性差異(P0.05),APTT、TT、FIB、F1+2、TAT、t-PA 和 PAI-1 兩組組內(nèi)比較無顯著性差異(P0.05);術(shù)后第3天,PT、APTT、TT、F1+2、TAT、t-PA組間比較差異無顯著性意義(P0.05),TURP組FIB高于HoLEP組,存在顯著性差異(P0.05),TURP組PAI-1高于HoLEP組,存在顯著性差異(P0.05);TURP組APTT及TT與術(shù)前比較下降,存在顯著性差異(P0.05),PT、FIB、F1+2、TAT、t-PA 和 PAI-1 組內(nèi)比較無顯著性差異(P0.05);HoLEP 組 PT、APTT、TT、FIB、F1+2、TAT、t-PA和PAI-1組內(nèi)比較無顯著性差異(P0.05)。術(shù)后2周及1月隨訪,65例患者均未發(fā)生血栓栓塞事件。結(jié)論:相對HoLEP,TURP術(shù)后的患者血液高凝,出現(xiàn)血栓栓塞事件的風險較高。
[Abstract]:Objective: to investigate the probability of thromboembolism in perioperative period of TURP and HoLEP by retrospective statistical analysis. The indexes of fibrinolysis and antifibrinolysis, as well as the routine examination of coagulation function. Prospective longitudinal and transverse comparison of transurethral Resection of The Prostate in transurethral resection of the prostate. TURP) and transurethral holmium laser enucleation of the prostate (TURP) and Holmium Enucleation of The Prostate. Hole P) was used to treat benign prostatic hyperplasia in patients with benign prostatic hyperplasia (BPH). Impact of perioperative thromboembolism risk. Methods: 1). The data of TURP and HoLEP in urology from January 2013 to March 2017 were analyzed retrospectively. To compare the proportion of thrombus related events between two groups.) 70 patients with benign prostatic hyperplasia were selected from June 2015 to March 2017 in a specific medical group. TURP group and HoLEP group were randomly divided into TURP group (35 cases) and Hole group (35 cases). Improve the pre-operation examination of prostate ultrasound, prostate specific antigen (PSA) determination, and routine examination before operation. Study indicators: before operation, 1 day after operation. On the third day after operation, four items of coagulation were detected: activated partial thromboplastin time (APTTT), prothrombin time (PTT), fibrinogen (FIBN) and thrombin time (TTT). Prothrombin fragment F12 and thrombin-antithrombin complex TAT. Plasminogen activator inhibitor (PAI-1) and tissue plasminogen activator (t-PA.). Postoperative observation and follow-up: 14 days after operation, deep vein ultrasonography was performed to observe and record postoperative complications. Routine follow-up was performed on January. Results from January 2013 to March 2017, 448 patients underwent TURP in our hospital. Among them, 3 cases had venous thrombosis of lower extremity with pulmonary infarction, only 1 case had pulmonary infarction. There were 426 patients undergoing HoLEP, of which 1 case had venous thrombosis of lower extremity, and 3 cases in TURP group had a history of cerebral infarction or cerebrovascular disease. In HoLEP group, 2 cases had a history of myocardial infarction, the rest had no history of cardiovascular and venous thrombosis or pulmonary embolism, no coagulation disorder, no use of antiplatelet or anticoagulant drugs. The detection of prostate specific antigen (PSA) was in the normal range, and 65 cases were included in the final effective cases, including 32 cases of TURP and 33 cases of HoLEP. There was no significant difference in F12, TATPAI-1, t-PA and coagulation between the TURP group and the control group (P 0.05). On the first day after operation, there was no significant difference between the two groups (P 0.05). The PAI-1 of TURP group was higher than that of HoLEP group, and there was significant difference (P 0.05). PT in HoLEP group and HoLEP group was higher than that before operation. There was no significant difference between the two groups (P0.05). There was no significant difference between the two groups (P0.05). On the 3rd day after operation, there was no significant difference in FIB between the two groups. The FIB of TURP group was higher than that of HoLEP group. There was significant difference in PAI-1 between P0.05TURP group and HoLEP group, and there was significant difference between P0.05TURP group and HoLEP group. The levels of APTT and TT in TURP group were significantly lower than those before operation (P 0.05). There was no significant difference between t-PA group and PAI-1 group (P 0.05). There was no significant difference between HoLEP group and PAI-1 group (P 0.05). All patients were followed up 2 weeks after operation and on January. Conclusion: the risk of thromboembolic events is higher than that of patients after Hole Pen TURP.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R699.8

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