摘要
目的:分析经尿道前列腺电切术(TURP)对勃起功能的影响程度及引起术后勃起功能障碍的各种 因素。方法:随访257例行TURP术患者,按年龄、前列腺切除重量、术前性功能状况、术后是否有低钠血症和术 中前列腺包膜是否穿破五个因素分别比较其作用下的术前术后性功能改变情况。并采用电切术切除犬前列腺组 织,观察其电切术后前列腺损伤深度及标志勃起神经功能的指标(一氧化氮活性),评估电切术对勃起神经损伤程 度的影响。结果:术中前列腺切除重量大小与术后是否有低钠血症发生对TURP术后勃起功能障碍的发生无明 显关系(P>0.05)。>65岁者与≤65岁者、术前性功能不完全者与术前性功能完全者、术中穿破前列腺包膜与 包膜完整者的三因素中,前者术后勃起功能障碍发生率均比后者高(P<0.05)。实验研究显示电切术损伤仅局 限于前列腺本身,最深仅为1.6mm。阴茎海绵体一氧化氮活性测定,术前术后差别无统计学意义。结论:年龄、 术前性功能状况、术中是否穿破前列腺包膜三因素对TURP术后勃起功能障碍影响明显。实验研究显示电切术 损伤仅局限于前列腺本身。经尿道前列腺电切术只要操作规范,手术本身并不引起术后勃起功能障碍。
Objective:To analyse the effect of transurethral resection of the prostate(TURP) on erectile function and the factors of postoperative erectile dysfunction.Methods:Follow-up of 257 patients was performed. According to age, resected tissue of prostate, preoperative sexual function, whether postoperative hyponatremia occurred or not and whether breach of prostatic capsule occurred or not, we compared alternation of postoperative sexual function under the varying conditions of above mentioned factors respectively. Animal model of the operation was established. The injury depth of prostate was observed. The total Nitrogen monoxide(NO) activity of Corpora Cavernosa of penis before and after operation was detected. The effect of TURP on the injury degree of erectile nerve was evaluated.Results:Resected tissue of prostate and postoperative hyponatremia were not related to postoperative impotence(P> 0.05). Risk of postoperative impotence was higher in men who were older than 65 years old or had iatrogenic capsular perforation. It was also higher in patients with preoperative partial erection(P< 0.05). TURP in the canine model revealed only a shallow remnant of necrosis with depth of less than 1.6 mm at the site of resection. There was no significant difference in NO activity of Corpora Cavernosa of penis between preoperative and postoperative duration.Conclusions:The age older than 65, iatrogenic capsular perforation and preoperative partial erection were risk factors of erectile dysfunction. Animal experiment showed only a shallow remnant of necrosis at the site of resection. TURP would not result in postoperative erectile dysfunction if the operation was performed normatively.
出处
《临床泌尿外科杂志》
2004年第12期712-714,共3页
Journal of Clinical Urology
