前立腺肥大症術後の血尿に対するトロンビンの効果について

Abstract

1)前立腺肥大症の術後出血に対し, トロンビン溶解液による前立腺床を含めた持続膀胱灌流を施行した.2)術後の肉眼的血尿持続期間については恥骨後式前立腺摘除術, 恥骨上式前立腺摘除術, TUR-Pの何れの群でもコントロール群に比較して有意差を認めなかった.3)術後の顕微鏡的血尿持続期間については恥骨上式前立腺摘除術群でコントロール群に比較し, 有意に顕微鏡的血尿持続期間の短縮を認め, 恥骨後式前立腺摘除術群でも顕微鏡的血尿の持続期間の短縮傾向を認めた.TUR-P群では差を認めなかった.4)自覚的副作用は特に認められなかった.APTT, トロンボテスト, プロトロンビン時間, TTT, ZTT, GOT, GPT値にトロンビンの影響によると思われる変動は認めなかった

The control of intra- and postoperative hemorrhage is as significant a problem following prostatectomy as postoperative urinary tract infection. We made a trial use of a solution of thrombin in continuous bladder lavage to control postoperative hemorrhage. A group of 21 patients with benign prostatic hyperplasia were treated by the thrombin lavage, with a group of 20 similar patients as controls. The treated group comprised 5 patients operated on by suprapubic, 11 by retropubic and 6 by transurethral prostatectomy, and the control group consisted of 6 patients operated on by suprapubic, 8 by retropubic, and 6 by transurethral prostatectomy. The thrombin lavage was, as a general rule, performed by lavaging the bladder with a solution of thrombin in physiological saline containing 100 units in each ml through an indwelling 3-way Foly catheter continuously for 24 hours following operation. There was no significant difference in the duration of macroscopic hematuria following operation by any operating technic between the control and the treated grove. The duration of microscopic hematuria was significantly shorter in the patients operated on by suprapubic prostatectomy and treated with thrombin than in the control group similarly operated on, and also tended to be reduced in the patients operated on by retropubic prostatectomy and treated with thrombin, compared with the controls similarly operated on. There was no significant difference in the duration between the patients operated on by transurethral technic. No particular adverse reactions to the thrombin lavage were observed.