経尿道的前立腺切除術の術中・術後出血に関する検討 - Morphine又はBuprenophineの硬膜外腔注入による術後出血抑制効果 -

Abstract

1)経尿道的前立腺切除術の術中出血は, 腺腫切除の前半に多く最初の30分間に術中出血量の約50%が失われていた.手術出血を少なくするためには, 動脈性出血をこまめに止めながら切除をすすめること, 一度に切除面を大きくせず一葉を半分位にわけ各部を被膜近くまで切除してから隣りに移るようにすること, 一葉の大半を切除したら対側に移り最後に残存する腺腫を根治的に切除するなどの手技の改良が必要と考えられた.2)前立腺手術の術後出血は, 膀胱テネスムスにより誘発増悪しており, 術後疼痛の出現を充分に抑えうれば再出血を防止しうると考えられた.硬膜外腔にmorphineあるいはbuprenophineを注入して, 術後出血量を対照群の30%にまで減少せしめえた.3)術後の止血が順調か否かは, 手術後数時間以内の経過にかかっており, TURP 2～4時間並びに6～8時間後の血尿濃度で術後出血型を推測しうるとともに, とるべき処置も選択しうる

The majority of hemorrhages occurring during open prostatectomy are induced during the steps for removal of adenoma. However, the hemorrhage during transurethral prostatic resection (TURP) usually takes place at its initial stage, and approx. 50% of the amount of the hemorrhage during the operation occurred within 30 minutes after initiating the operation. When the resection of the adenoma advanced near the surgical capsule, the amount of hemorrhage decreased sharply. This was interpreted to indicate that many of the blood vessels are cut at the initial stage of the operation and that the steps for resection are processed at that stage without special attempt to stop the hemorrhage. We have discussed some aspects for improvement of the methodology for the operation of this kind. The postoperative progress of hemorrhage revealed that the operative cases can be classified into three groups; one was the group with smooth hemostasis since immediately after the operation (Type I and II) and the others were the group with satisfactory hemostasis during the operation and yet with resumption of substantial hematuria (Type III and IV) and the group with continued hemorrhage of substantial amount since immediately after the operation (Type V). It was demonstrated that those showing hematuria of more than 2% at 2-4 hours after the operation and 0.5-1.9% at 6-8 hours after the operation can be rated as falling under the latter two groups and that the check at an early stage and early counter-treatment would induce favorable postoperative progress.(ABSTRACT TRUNCATED AT 250 WORDS)