雙極性食鹽水TURP可降低稀釋性低血鈉症風險


  Aug. 26, 2004 - 一項發表於8月號泌尿學(Urology)期刊的小型試驗結果顯示,大體積良性前列腺肥大(BPH)與患有其他疾病患者,使用雙極性食鹽水經尿道切除前列腺(TURP)手術,可以降低稀釋性低血鈉症風險。
  
  喬治亞州亞特蘭大市艾摩雷大學醫學院Muta M. Issa醫師指出,理論上,生理食鹽水是TURP理想的灌洗溶液,然而,它的導電特性限制它使用於傳統單極性TURP系統。
  
  研究人員表示,傳統TURP手術使用低張性非導電性液體,例如甘氨酸、山梨醇或甘露醇,且它們手術中的吸收造成稀釋性低血鈉症,一種TURP症候群的標準特徵。
  
  為了評估降低副作用發生的可能性,研究人員讓5位病患使用新型雙極性直腸鏡,以生理食鹽水來執行TURP手術;收納條件是大體積前列腺切除重量(大於35公克)及顯著的其他疾病,包括心房撲動、鬱血性心臟衰竭、高血脂、冠狀動脈心血管疾病、周邊血管疾病、腦血管疾病、與創傷後壓力症候群(美國麻醉學會風險分類第3級)。
  
  病患平均年齡為68歲(範圍從57-76歲),平均切除前列腺重量為49.6公克(範圍從37-62公克);雙極性生理食鹽水TURP手術由受監督的泌尿科住院醫師執行,平均手術時間為2個小時又22分鐘(範圍從98-175分鐘)。
  
  相較於手術前,平均手術後血中鈉離子濃度每100毫升降低了1.6毫克(範圍從每100毫升138.4-136.8毫克),術後平均血比容也比術前降低5.60%(範圍從40.24-34.64%)。
  
  術後所有病患都很順利地恢復,而且沒有副作用發生。
  
  研究人員指出,雙極性生理食鹽水TURP手術是安全的、且可降低因大體積前列腺而需要長時間手術的高危險群病患,發生TURP症候群的風險;此外,這個系統允許職員教導與訓練泌尿科住院醫師,同時不會危及病患安全。

Bipolar Saline TURP Eliminates

By Yael Waknine
Medscape Medical News

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Aug. 26, 2004 — Bipolar saline transurethral resection of the prostate (TURP) in patients with large-volume benign prostatic hyperplasia (BPH) and significant comorbidities eliminates the risk of dilutional hyponatremia, a hallmark of TURP syndrome, according to the results of a small study published in the August issue of Urology.

"Theoretically, normal saline is the ideal irrigation fluid for TURP," write Muta M. Issa, MD, MBA, from the Emory University School of Medicine in Atlanta, Georgia, and colleagues. "However, its electrical conducting properties prohibit its use with conventional monopolar TURP systems."

According to the authors, conventional TURP uses hypotonic nonconductive fluids such as glycine, sorbitol, and mannitol, and their intraoperative absorption results in dilutional hyponatremia, a standard characteristic of TURP syndrome.

To evaluate the possibility of reducing the risk of this adverse event, the investigators performed TURP in five patients using a new bipolar resectoscope that allows the use of normal saline. Inclusion criteria were large prostate resection weight (> 35 g) and significant comorbidities, including atrial fibrillation, congestive heart failure, hyperlipidemia, coronary artery disease, peripheral vascular disease, cerebrovascular accident, and posttraumatic stress disorder (American Society of Anesthesiologist risk classification 3).

Mean patient age was 68 years (range, 57-76 years). Mean resected prostatic chip weight was 49.6 g (range, 37-62 g). Bipolar saline TURP was performed by supervised urology residents in an average operative time of two hours, 22 minutes (range, 98-175 minutes).

Mean postoperative serum sodium concentration decreased from preoperative levels by 1.6 mg/dL (range, 138.4 - 136.8 mg/dL). Posoperative mean hematocrit levels also decreased by 5.60% from preoperative measurements (range, 40.24% - 34.64%).

All patients had an uneventful postoperative recovery and no adverse events were reported.

"Bipolar saline TURP is safe and eliminates the risk of TURP syndrome in high-risk patients with large prostates that require lengthy resection," the authors write. "In addition, the system permits the faculty to spend the time needed for teaching and training urology residents without compromising patients' safety."

The authors report no pertinent financial disclosures.

Urology. 2004;64:298-301

Reviewed by Gary D. Vogin, MD

    
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