前立腺摘除術におけるイプシロン投与法に関する1,2の考察

Abstract

As known, postoperative bleeding in prostatectomy can be successfully treated with an inhibitor of , fibrinolytic activity, epsilon-amino-caproic acid (E-ACA) . Nevertheless, the clear view on the effective dose and method of a d ministration of E7ACA can not be found anywhere. The purpose of this stu d y was to assess the influence of fibrinolysis promoting factors in the hemostasis at the operation site by the examination of blood and urine . The fibrinolytic activity of plasma euglobulin, plasma euglobulin plus SK, antiplasmin and urine activator were assayed on fibrin plate by the method of Astrup & Miilierz , before operation and during the first 20 days of th postoperative period. One group was composed of 11 patients with prostatic hypertrophy, who were treated with E-ACA for 6-9 days after prostatectomy in doses varying between 8g and 12g per day. Another group was composed of 4 patients with prostatic hypertrophy who were treated with EACA for 5-.7 days after prostatectomy in doses varying between 8g and lOg per day, and 2g was reduced per day from the next day. The activity of urine activator exhib i ted the most remarkable change after operation, namely a extermely increased activity was found during the first 3 days of the postoperative period, and on the following day its activity was remarkably decreased. When the treatment with E-ACA was stopped, the activity of urine activator increased again. It seems probable that the increased fibrinolytic activity is due to the rebound phenomenon by withdrawal of E-ACA. The decrease in order of the dose of E-CAC protected the increase of urine activator from the rebound phenomenon. It is most likely that the occurence of extremely high acitvity of urine activator has an important influence on the bleeding after prostatectomy which may occur after an interval, during which hemostasis was satisfactory at the operation site. Therefore the treatment with E -ACA must be carried out more frequently during operation and an early stage of postoperative period for inhibition of high activity of urine activator, and followed by the decrease in order of the dose of E-ACA. Moreover the infusion of E-ACA into the prostatic cavity may b e the useful method for the purpose of inhibition of local fibrinolytic activity.