前立腺容積100ml以上の前立腺肥大症に対する経尿道的前立腺切除術 - より安全に手術を行うための治療戦術としての前立腺組織内レーザー凝固術Plus酢酸クロルマジノン術前治療 -

Abstract

経尿道的前立腺切除術(TURP)を施行した前立腺容積100ml以上の前立腺肥大症(BPH)18例を対象とし, TURPの手術成績(A群:14例)と「前立腺組織内レーザー凝固術(ILCP)plus酢酸クロルマジノン(CMA)」術前治療を行った手術成績(B群:4例)について検討した.切除重量平均は, A群で93.1g, B群で60.5g, 平均手術時間はそれぞれ66.3分, 55.7分であった.A群の輸血頻度は12例(85.7%), 輸血量は平均583mlであった.B群では, 「ILCP plus CMA」にて平均前立腺容積は治療前110mlから治療6ヵ月後81.3mlに減少した.B群の血中ヘモグロビン値は, 術前平均12.5g/dl, 術直後平均10.7g/dlであり, 1例のみ術翌日9.0g/dlとなり400mlの輸血を行った.合併症は, A群の1例に球部尿道狭窄を術後3ヵ月後に認めた.「ILCP plus CMA」術前治療によるTURPは, 100ml以上のBPHに対する安全な治療法の1つとして, その有用性が認められた

Between August 1985 and March 2004, we performed transurethral resection of the prostate (TURP) in 18 patients with benign prostatic hyperplasia (BPH) whose prostatic volume was larger than 100 ml. We divided the patients into two groups. Group A consisted of a total of 14 cases: 10 cases whose mean prostate volume was 114 ml (100 to 137 ml) and 4 cases whose prostate volume was not measured before TURP but whose mean resected prostatic tissue weight was 113 g (105 to 118 g). Group B consisted of 4 cases whose mean prostate volume was 110 ml (101 to 133 ml). Patients in group B underwent interstitial laser coagulation of the prostate (ILCP) followed by oral chlormadinone acetate (CMA) therapy (50 mg/day); TURP was performed 6 months later, once the prostate volume had shrunk to an average of 76 ml (66 to 91 ml). Mean resected weights and operation times were: group A, 93.1 g, 66.3 min; group B, 60.5 g, 55.7 min. There were 12 blood transfusion cases (85.7%; intraoperative) in group A, and 1 (25.0%; POD 1) in group B. Accordingly, this preoperative treatment was considered a safer method of TURP for BPH 100 ml or more. There were no cases of TURP syndrome or death in either group.