非那雄胺对TURP术中术后出血的影响
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摘要
目的：评价术前术后服用非那雄胺对经尿道前列腺电切除术(transurethral resection of prostate,TURP)术中术后出血的影响。
方法：60例良性前列腺增生症(benign prostatic hyperplasia,BPH)患者,对于术前7天及术后3周服用非那雄胺5mg的20例患者纳为5mg组,服用10mg的20例患者纳为10mg组,未服用非那雄胺的20例患者纳为对照组,比较三组TURP手术时间、术中冲洗液量、术中失血量、术后冲洗时间、术后冲洗液量、出血指数、出血强度及术后镜下血尿转阴时间。免疫组织化学SP法测定前列腺组织中的微血管密度(microvessel density,MVD)、血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达。
结果：60例TURP术均获得成功。与对照组组比较,服药组的手术时间、术中冲洗液量、术中失血量、术后冲洗时间、术后冲洗液量均显著降低,差异有统计学意义(P<0.05),但是5mg组与10mg组没有明显差异(P>0.05)；对照组和5mg组、10mg组平均出血指数分别为(8.9±5.2)ml/g、(6.2±4.2)ml/g、(5.8±3.6)ml/g;平均出血强度分别为(4.30±1.70)ml/min、(3.30±1.50)ml/min、(2.93±1.03)ml/min。服药组出血指数和出血强度较对照组明显减少,其差异有统计学意义(P<0.05)；但是5mg组与10mg组的差异无统计学意义(P>0.05)。服药组与对照组前列腺组织平均血管密度、最大血管密度和VEGF表达差别有显著性意义(P<0.05)。5mg组与10mg组前列腺组织平均血管密度、最大血管密度和VEGF表达差别无显著性意义(P>0.05)。术后镜下血尿转阴时间,与对照组比较服药组明显缩短(P<0.05),且5mg组与10mg组有明显差异(P<0.05),即10mg组的镜下血尿转阴时间更短。
结论：术前应用非那雄胺7天能够有效减少TURP术中术后失血量,短期加大剂量并不能增加疗效；术后应用非那雄胺10mg/d的能够明显缩短TURP术后镜下血尿阴转时间,减少术后出血。
Objective:To evaluate the effect of finasteride on perioperative and postoperative bleeding following transurethral resection of prostate (TURP).
Methods:60 patients with BPH were scheduled for TURP,20 of them were received 5mg of finasteride daily for seven days before surgery and three weeks after surgery,20 of them were received 10mg, the other 20 patients were not received. A comparative study of clinical data was made between the three groups. Microvessel density (MVD) and vascular endothelial growth factors (VEGF) expression were measured by immunohistochemistry SP method in prostatic tissue.
Results:Compared to non-overdose group, operation time, intraoperative irrigating fluid volume, intraoperative blood loss, postoperative irrigating time, postoperative irrigating fluid volumein finasteride group were significantly less (P<0.05),but there in the 10mg group were not significantly less compared with 5mg group(P>0.05). Similarly the bleeding index and intensity were significantly less (P<0.05) compared to non-overdose group, but there in the 10mg group were not significantly less compared with 5mg group(P>0.05). the mean and max value of MVD and the mean rank of VEGF were significantly less (P<0.05) compared to non-overdose group, but there in the 10mg group were not significantly less compared with 5mg group(P>0.05).The duration of hematuria associated with TURP were significantly less (P<0.05) in 10mg group.
Conclusion:The use of finasteride before TURP can reduce perioperative bleeding, large dose don't increase therapeutic effect in the short period; The use of 10mg finasteride after TURP can shorten the duration of hematuria associated with TURP.
方法：60例良性前列腺增生症(benign prostatic hyperplasia,BPH)患者,对于术前7天及术后3周服用非那雄胺5mg的20例患者纳为5mg组,服用10mg的20例患者纳为10mg组,未服用非那雄胺的20例患者纳为对照组,比较三组TURP手术时间、术中冲洗液量、术中失血量、术后冲洗时间、术后冲洗液量、出血指数、出血强度及术后镜下血尿转阴时间。免疫组织化学SP法测定前列腺组织中的微血管密度(microvessel density,MVD)、血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达。
结果：60例TURP术均获得成功。与对照组组比较,服药组的手术时间、术中冲洗液量、术中失血量、术后冲洗时间、术后冲洗液量均显著降低,差异有统计学意义(P<0.05),但是5mg组与10mg组没有明显差异(P>0.05)；对照组和5mg组、10mg组平均出血指数分别为(8.9±5.2)ml/g、(6.2±4.2)ml/g、(5.8±3.6)ml/g;平均出血强度分别为(4.30±1.70)ml/min、(3.30±1.50)ml/min、(2.93±1.03)ml/min。服药组出血指数和出血强度较对照组明显减少,其差异有统计学意义(P<0.05)；但是5mg组与10mg组的差异无统计学意义(P>0.05)。服药组与对照组前列腺组织平均血管密度、最大血管密度和VEGF表达差别有显著性意义(P<0.05)。5mg组与10mg组前列腺组织平均血管密度、最大血管密度和VEGF表达差别无显著性意义(P>0.05)。术后镜下血尿转阴时间,与对照组比较服药组明显缩短(P<0.05),且5mg组与10mg组有明显差异(P<0.05),即10mg组的镜下血尿转阴时间更短。
结论：术前应用非那雄胺7天能够有效减少TURP术中术后失血量,短期加大剂量并不能增加疗效；术后应用非那雄胺10mg/d的能够明显缩短TURP术后镜下血尿阴转时间,减少术后出血。
Objective:To evaluate the effect of finasteride on perioperative and postoperative bleeding following transurethral resection of prostate (TURP).
Methods:60 patients with BPH were scheduled for TURP,20 of them were received 5mg of finasteride daily for seven days before surgery and three weeks after surgery,20 of them were received 10mg, the other 20 patients were not received. A comparative study of clinical data was made between the three groups. Microvessel density (MVD) and vascular endothelial growth factors (VEGF) expression were measured by immunohistochemistry SP method in prostatic tissue.
Results:Compared to non-overdose group, operation time, intraoperative irrigating fluid volume, intraoperative blood loss, postoperative irrigating time, postoperative irrigating fluid volumein finasteride group were significantly less (P<0.05),but there in the 10mg group were not significantly less compared with 5mg group(P>0.05). Similarly the bleeding index and intensity were significantly less (P<0.05) compared to non-overdose group, but there in the 10mg group were not significantly less compared with 5mg group(P>0.05). the mean and max value of MVD and the mean rank of VEGF were significantly less (P<0.05) compared to non-overdose group, but there in the 10mg group were not significantly less compared with 5mg group(P>0.05).The duration of hematuria associated with TURP were significantly less (P<0.05) in 10mg group.
Conclusion:The use of finasteride before TURP can reduce perioperative bleeding, large dose don't increase therapeutic effect in the short period; The use of 10mg finasteride after TURP can shorten the duration of hematuria associated with TURP.
引文
[1]Berry SJ,Coofey DS,Walsh PC,et al. The development of human benign prostatic hyperplasia with age.J Urol,1984,132:474-479.
[2]陈曾德.前列腺增生手术治疗[M]//吴阶平.吴阶平泌尿外科学.济南：山东科学技术出版社,2004：1187-1197.
[3]Shih S J, Dall Era MA, Westphal J R, et al. Elements regulating angiogenesis and correlative microvessel density in benign hyperplastic and malignat prostate tissue. Prostate Cancer Prostatic Dis,2003,6:131-137
[4]Baileyo DM, Foley SJ. Microvacular anatomy in patients with recurrent haematuria related to prostatic hypertrophy. J Urol,1999,161:865
[5]Marshall S, Narayan P. Treatment of prostatic bleeding:suppression of angiogenesis by androgen deprivation. J Urol,1993,149:1553-1554.
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[8]Luke M, Kvist E, Anderson F, et al. Reduction of postoperative bleeding after transurethral resection of the prostate by local instillation of fibrin adhesive(Beriplast).
[9]Walker EM, Bera S and Faiz M. Does catheter traction reduce post-transurethral resection of the prostate blood loss? Br J Urol,1995,75:614-617.
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[11]Gormley GJ, Stoner E, Bruskewitz RC, et al. For the Finasteride Study Group:The effect of finasteride in men with benign prostatic hyperplasia.N Engl J Med,1992,327:1185-1191.
[12]Sieber P R,Rommel F M,Huffnagle H W, et al. The treatment of gross Bleeding with Finasteride [J].J Urol,1998,159:1232-1233.
[13]方伟杰,张斌斌.非那雄胺治疗TURP术后血尿[J].现代泌尿外科杂志, 2003,8 (1):35.
[14]Jenniferr A, Ha Gerty, Phillip C, et al. Pretreatment with finasteride decrease perioperative bleeding associated with transueth ral resection of the prostate[J].Urology,2000,55(5):684-689.
[15]Hagerty JA, Ginsberg PC, Harmon JD, et al. Prereatment with finasteride decreases perioperative bleeding associatd with transurethral resection of the prostate[J].Urology,2000,55(5):684-689.
[16]Bailey D M, Foley S J. Microvacular anatomy in patients with recurrent Hemoturia related to prostatic hypertrophy [J]. J Urol,1999,161:225-227.
[17]Foley S J, Soloman L Z, Wedderburn A W,et al. A prospective study of the natual history of hematuria associated with benign prostatic hyperplasia and the effect of Finasteride [J] J Urol,2000,163 (2):496-498.
[18]Pareek G,Shevchu KM,Armena Kasna,et al. The effect of finasteride on the expression of vascular endothelial growth factor and microvessel density:a possible mechanism for decreased prostatic bleeding in treated patients [J]. J Urol,2003,169 (1):20-23.
[19]Ha Ggstrom S, Torrin G N, Moller K, et al.Effects of finasteride on vascular endothelial growth factor [J].Scand J Urol Nephrol,2002,36(3):182-187.
[20]刘孝东,杨宇如,卢一平,等.非那雄胺减少TURP术中出血的机理研究[J].中华泌尿外科杂志,2003,24(10)：6942696.
[21]李恭会,何正富,余大敏,等.非那雄胺对经尿道前列腺切除术中出血和冲洗液吸收影响的定量性研究.浙江大学学报医学版,2004,33：258-260.
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[23]Ha Ggstrom S, Torrin G N, Moller K, et al.Effects of finasteride on vascular endothelial growth factor [J].Scand J Urol Nephrol,2002,36(3):182-187.
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[45]Perimenis P, Gyf topoulos K, Markou S,et al. Effects of finasteride and cyproterone acetate on hematuria associated with benign prostatic hyperplasia:a prospective, randomized, cont rolled study. Urology,2002,59:373-377.
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[2]陈曾德.前列腺增生手术治疗[M]//吴阶平.吴阶平泌尿外科学.济南：山东科学技术出版社,2004：1187-1197.
[3]Shih S J, Dall Era MA, Westphal J R, et al. Elements regulating angiogenesis and correlative microvessel density in benign hyperplastic and malignat prostate tissue. Prostate Cancer Prostatic Dis,2003,6:131-137
[4]Baileyo DM, Foley SJ. Microvacular anatomy in patients with recurrent haematuria related to prostatic hypertrophy. J Urol,1999,161:865
[5]Marshall S, Narayan P. Treatment of prostatic bleeding:suppression of angiogenesis by androgen deprivation. J Urol,1993,149:1553-1554.
[6]Puchner PJ and Miller MI. The efects of finasteride on hematuria associated with benign prostatic hyperplasia:a preliminary report.J Urol,1995,154:1779-1782.
[7]Gray N and Polakow E S:A study of Premarin intravenous and its influence on blood lossd uring transurethral prostatectomy.J Int MedR es,1979,7:96-99.
[8]Luke M, Kvist E, Anderson F, et al. Reduction of postoperative bleeding after transurethral resection of the prostate by local instillation of fibrin adhesive(Beriplast).
[9]Walker EM, Bera S and Faiz M. Does catheter traction reduce post-transurethral resection of the prostate blood loss? Br J Urol,1995,75:614-617.
[10]Szewczyk W:Blood loss during transurethral resection of the prostate injected with phenol solution.Int Urol Nephrol,1991,23:155-159.
[11]Gormley GJ, Stoner E, Bruskewitz RC, et al. For the Finasteride Study Group:The effect of finasteride in men with benign prostatic hyperplasia.N Engl J Med,1992,327:1185-1191.
[12]Sieber P R,Rommel F M,Huffnagle H W, et al. The treatment of gross Bleeding with Finasteride [J].J Urol,1998,159:1232-1233.
[13]方伟杰,张斌斌.非那雄胺治疗TURP术后血尿[J].现代泌尿外科杂志, 2003,8 (1):35.
[14]Jenniferr A, Ha Gerty, Phillip C, et al. Pretreatment with finasteride decrease perioperative bleeding associated with transueth ral resection of the prostate[J].Urology,2000,55(5):684-689.
[15]Hagerty JA, Ginsberg PC, Harmon JD, et al. Prereatment with finasteride decreases perioperative bleeding associatd with transurethral resection of the prostate[J].Urology,2000,55(5):684-689.
[16]Bailey D M, Foley S J. Microvacular anatomy in patients with recurrent Hemoturia related to prostatic hypertrophy [J]. J Urol,1999,161:225-227.
[17]Foley S J, Soloman L Z, Wedderburn A W,et al. A prospective study of the natual history of hematuria associated with benign prostatic hyperplasia and the effect of Finasteride [J] J Urol,2000,163 (2):496-498.
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