Рецепт. 2020; : 493-501
Интраоперационная кровопотеря при хирургическом лечении доброкачественной гиперплазии предстательной железы
https://doi.org/10.34883/PI.2020.23.4.003Аннотация
Доброкачественная гиперплазия предстательной железы (ДГПЖ) является одним из самых распространенных заболеваний органов мочеполовой системы у мужчин. По данным EAU, наряду с малоинвазивными методами открытая аденомэктомия остается актуальной методикой хирургического лечения при большом объеме простаты. Кровотечения, частота которых в раннем послеоперационном периоде составляет от 0,2% до 10%, являются самым частым осложнением аденомэктомии. В Республике Беларусь выполняется большое количество открытых операций по поводу ДГПЖ (38,6–40,1%).В период с 2016 по 2019 год пациентам (n=87), отобранным методом случайных чисел при помощи компьютерной программы (Random Number Generator v 1.3), выполнялась открытая чреспузырная аденомэктомия. Гемостаз выполняли путем прошивания шейки мочевого пузыря (на 12 часах циферблата) нитью ПГА (2/0) и временным марлевым тампонированием ложа. Интраоперационную кровопотерю учитывали по объему крови на операционном материале и в вакуумном резервуаре. Возраст пациентов составил 70,3±7,4 года; IPSS – 29,5±2,8 балла; QoL – 5,5±0,5; объем простаты – 112,7±42,2 см3; PSAtot. – 8,1 нг/мл; время операции – 76,9±19,9 минуты. Перед операцией уровень гемоглобина составил 145±16 г/л, в первые сутки после операции – 119±17 г/л, на вторые сутки – 106±15 г/л. Эритроциты крови до операции – 4,73±0,64×1012, в первые сутки послеоперационного периода – 3,93±0,60×1012, на вторые сутки – 3,42±0,60×1012. Гематокрит существенно снизился ко 2-м суткам с 43,4±4,8 до 31,4±4,3% (р<0,0001). Интраоперационная кровопотеря составила 223,3±73,7 мл, а частота гемотрансфузий – 12,6%. Cтепень интраоперационной кровопотери не зависит от наличия надлобкового дренажа мочевого пузыря (p>0,05).
Список литературы
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Recipe. 2020; : 493-501
Intraoperative Blood Loss in the Surgical Treatment of Benign Prostatic Hyperplasia
https://doi.org/10.34883/PI.2020.23.4.003Abstract
References
1. Gravas S., Cornu J.N., Gacci M. (2019) EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-the-Management-of-Non-Neurogenic- Male-LUTS-2019.pdf.
2. Naspro R. (2006) Holmium laser enucleation of the prostate versus open prostatectomy for prostates > 70 g: 24-month follow-up. Eur Urol, vol. 50, pp. 563.
3. Strotsky A.V. (2018) Urology. Minsk: New edition, pp. 103–104.
4. Nitkin D.M. (2020) City scientific and practical meeting on the results of the work of the urological service of Minsk for 2017–2019. Report of the rector of BelMAPO, chief freelance urologist of the Ministry of health of the Republic of Belarus. March 13.
5. Lopatkin N.A. (1995) Urology. Moscow: Medicine, 402 p.
6. Sergienko N.F., Vasil’chenko M.I., Kudryashov O.I., Lototskiy M.M., Begaev A.I., Shchekochikhin A.V., Shershnev S.P., Reynyuk O.L. High-technology extraurethral prostatectomy, pp. 58–61.
7. Pevzner P.N. (2005) Open Prostatectomy. New Suggestions for the Complications Prevention. Velikiy Novgorod, pp. 15–18.
8. Kotov S.V., Mamaev I.E., Yusufov A.G. (2017) Comparison of the results of laparoscopic and open posterior prostatectomy. Proceeding of the XVII Congress of the Russian Society of Urology. "110 years of the Russian Society of Urology" (November 8–10, 2017), Moscow, 364 p.
9. Sayidov T.N., Novoselov V.G., Zyryanov A.V. (2017) Experience of retropubic prosatomectomy in the treatment of choice in patients with large prostate volume. Proceeding of the XVII Congress of the Russian Society of Urology. "110 years of the Russian Society of Urology" (November 8–10, 2017), Moscow, 374 p.
10. Gratzke C., Schlenker B., Seitz M. (2007) Complications and early postoperative outcome after open prostatectomy in patients with benign prostatic enlargement: results of a prospective multicenter study. J. Urol.; 177(4), pp. 1419–22.
11. Ragimov A.A. (2011) Autodoning and Autohemotransfusion. Moscow, pp. 35–40.
12. Staroverov A.T., Kapralova A.I., Kulikov L.V. (1979) Nomogram for determining the globular volume of blood. Anesthesiol. and reanimatol., no 1, pp. 22–24.
13. Gupta A. (2008) Use of the Hemosue near patient testing device to measure the concentration of haemoglobin in suction fluid at elective Caesarean section. Anaesthesia, vol. 63, no 5, pp. 351–354.
14. Abakumov M.M., Lozhkin A.V., Khvatov V.B. (2002) Assessment of the volume and degree of blood loss in chest and abdominal trauma. Surgery, no 11, pp. 4–7.
15. Kocsis L., Herman R., Eke A. (2006) Mathematical model for the estimation of hemodynamic and oxygenation variables by tissue spectroscopy.J. Theor. Biol., Jul 21; vol. 241(2), pp. 262–275.
16. Kochanov D.A. (2008) Abstract of dissertation candidate of medical sciences. Plasma fluorimetry technique for measuring the volume of circulating blood. Moscow, pp. 5–15.
17. Pranoich A.A., Simchenko N.I., Shurinyuk N.M. (2010) Bipolar transurethral resection of BPH. Actual issues of specialized medical care, new directions in medicine. Materialy Respublicanskoy nauchno-prakticheskoy konferentsii. Minsk, pp. 219–211.
18. Mamoulakis C. (2009) Bipolar versus monopolar transurethral resection of the prostate: a systemic review and metaanalysis of randomized contlolled trails. Eur. Urol., vol. 56, pp. 798.
19. Madersbacher S. (1999) Is transurethral resection of the prostate still justified? BJU Int., vol. 83, pp. 227.
20. Glybochenko P.V., Alyaev Yu.G., Rapoport L.M. (2017) Comparative analysis of the effectiveness of various methods of endoscopic prostate enucleation in a single center. Proceeding of the XVII Congress of the Russian Society of Urology. "110 years of the Russian Society of Urology" (November 8–10, 2017), Moscow, 361 p.
21. Marien T., Kadihasanoglu M., Miller N.L. (2016) Holmium laser enucleation of the prostate: patient selection and perspectives. Res. Rep. Urol., vol. 8, pp. 191–192.
22. Mamaev I.E, Kravets A.A., Pronkin E.A. (2017) Laparoscopic retropubic prostatectomy. Surgical and functional results. Proceeding of the XVII Congress of the Russian Society of Urology. "110 years of the Russian Society of Urology" (November 8–10, 2017), Moscow, 368 p.
23. Kovalevskaya V.I., Rad’kov I.V., Prezov A.I. Surgical treatment of patients with benign prostatic hyperplasia. Proceeding of the 2 Congress of urologists of the Republic of Belarus (June 21–22, 2013), Minsk, Collected works, pp. 116–118.
24. Pravnovich A.A., Voshchula V.I. Comparative analysis of complications of early postoperative period of prostatectomy and TURP. Proceeding of the 2 Congress of urologists of the Republic of Belarus (June 21–22, 2013). Minsk, Collected works, pp. 161–166.
25. Martov A.G., Ergakov D.V., Turin D.E., Andronov A.S. (2020) Bipolar and laser endoscopic enucleation of large-sized BPH. Urology, no 1, pp. 59–63.
26. Rapoport L.M., Sorokin N.I., Sukhanov R.B. (2018) Holmium laser enucleation of BPH with a single block (HoLEP en bloc): our experience. Urology, no 3, pp. 83–86.
27. Davydov D.S., Tsarichenko D.G., Bezrukov E.A. (2018) Complications of holmium laser enucleation of the prostate. Urology, no 1, pp. 42–45.
28. Biktimirov R.G., Martov A.G., Biktimirov T.R. (2018) Comparative study of extraperitoneoscopic prostatectomy and monopolar transurethral resection in the surgical treatment of benign prostatic hyperplasia with a volume of 100–180 cm3. Urology, no 3, pp. 88–91.
29. Mariano M.B., Tefilli M.V., Graziotti T.M. (2006) Laparoscopic prostatectomy for benign prostatic hyperplasia – a six-year experience. Eur Urol., vol. 49, pp. 127–131.
30. Shakhmachev V.N. (2010) Comparative evaluation of hemostasis methods in open adenomectomy. Urology, no 6, pp. 20–23.
31. Garcia- Segui A., Angulo J.C. (2016) Prospective study comparing laparoscopic and open adenomectomy: Surgical and functional results. Actas Urol Esp., pp. 1–7.
32. Sevryukov F.A., Sorokin D.A., Chebykin A.V., Puchkin A.B., Karpukhin I.V. (2010) Transurethral enucleation of the prostate (TUEB) – an alternative to open prostatectomy. Proceeding of the Second Russian Congress on endourology and new technologies. Materials of the Congress. M., pp. 149–151.
33. Sevryukov F.A., Sorokin D.A., Karpukhin I.V., Puchkin A.B., Semenychev D.V., Kochkin A.D. (2012) Transurethral prostate enucleation (TUEB) is a new method of bipolar endoscopic BPH surgery. Experimental and clinical urology, no 2, pp. 34–36.
34. Mukhtarov S.T. (2002) Development, testing, implementation and evaluation of the effectiveness of new methods and means of minimally invasive treatment of benign prostatic hyperplasia (PhD Thesis). Tashkent, pr. 75–76.
35. Pevzner P.N. (2004) Prevention of bleeding, inflammatory and obstructive complications of percutaneous adenomectomy. Moscow, pp. 7–12.
36. Molchanov I.V., Goldina O.A., Gorbachevskiy Y.V. (1998) Solutions of hydroxyethylated starch are modern and effective plasma substitutes for infusion therapy. Monographic review. Moscow: Publishing house of the A.N. Bakulev ncssh, RAMS, 138 p.
37. Kuznetsov N.A. (2003) Modern technologies of treatment of acute blood loss. Consilium medicum, no 6, pp. 347–357.
38. Mikaelyan S.D. (1998) Abstract of the dissertation for the degree of candidate of medical sciences, St. Petersburg, pp. 8–15.
