경요도적 전립선절제술중의 실혈량 및 혈청전해질변화

Abstract

The main problems of transurethral prostatectomy were operative blood loss and absorption of irrigating fluid. Blood loss is a significant factor in the morbidity and mortality of prostatic surgery. Early recognition while surgery is being performed is important to prevent development of hypovolemia, especially in the aged group. The reduced serum sodium and osmolarity concentration, regarded as cause of TURP syndrome, was caused by dilution by several liters of irrigating fluid. To better understand the hemodynamic changes occurring in patients undergoing transurethral prostatectomy, from January 1989 to July 1989, a program for prospective study of blood loss measurement, serum electrolytes change and other related factors was undertaken in 21 patients undergoing TURP by use of manufactured URIONE solution(Sorbitol 2.7gm + Mannitol 0.54gm/ 100ml distilled water) solution as irrigating fluid. An accurate measurement of blood was obtained by Hemoglobincyanide method, a colorimetric determination of hemoglobin in the irrigating fluid. Statistical evaluation of all data obtained was made using the ""t test"" with significance at 6 percent or less. There was a significant postoperative decrease in serum sodium and osmolality concentration, respectively averaging 3.7 ± 3.8mEq/1, 8.4 ± 8.1mOsm/kg. They were not correlated with absorbed irrigant fluid volume, resection time, weight of tissue resected( P>0.05). Blood loss ranged from 18 to 1250ml and its mean was 178ml. A statistically significant positive interrelationship was found among operative blood loss, resection time, irrigating fluid volume. Also significant correlation could be gained between absorbed irrigant fluid volume and serum sodium change(P<0.05 ), and resection weight and irrigation fluid volume(P<0.05). Key word : TURP syndrome, Absorbed irrigating fluid volume.