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目的:探讨经尿道前列腺切除术(TURP)中对前叶区域切割是否损伤尿道横纹肌括约肌可能。方法:对60例经尿道前列腺切除术患者进行前叶切割,根据切割范围分为近端浅、深层组(1、2组),远端浅、深层组(3、4组),将切割区域前叶组织作HE染色,并通过免疫组化方法鉴定肌动蛋白(SMA)和肌红蛋白来检测切割组织中的平滑肌及横纹肌成分;计算横纹肌阳性及阴性结果所对应病例的前列腺体积、年龄、PSA,比较2、3、4组中横纹肌相对含量,用独立样本组间t检验进行统计分析。结果:切割前叶区域组织经HE染色和免疫组化检测提示确实存在尿道横纹肌括约肌分布,且平滑肌与横纹肌的组织学结构相互嵌杂;尿道横纹肌括约肌的切割损伤与前列腺体积有关;前叶组织中尿道横纹肌的分布趋势为近前列腺尖部增加,且向尿道腔方向伸入。结论:经尿道前列腺切除术中不应过多切割前叶区域,以避免尿道横纹肌括约肌的直接损伤。对于前列腺体积相对较小的患者,以及对前列腺尖部附近操作时,这一原则尤为重要。
Objective: To investigate whether transurethral resection of the prostate (TURP) may damage the urethral sphincter of the anterior segment of the urethra. Methods: Sixty cases of transurethral resection of the prostate underwent anterior leaflet cutting. According to the cutting range, they were divided into shallow and deep proximal group (group 1 and group 2), distal shallow and deep group (group 3 and 4) The anterior leaf tissue was stained with HE, and the actin (SMA) and myoglobin were identified by immunohistochemistry to detect the components of smooth muscle and striated muscle in the cut tissue. The prostatic volume, age, PSA. The relative content of striated muscle in groups 2, 3, and 4 were compared and statistically analyzed by t-test between independent sample groups. Results: HE staining and immunohistochemical examination of the anterior lobe showed that the sphincter of urethra did exist, and the histological structure of smooth muscle and striated muscle were interwoven. The incision injury of sphincter of urethra was related to the volume of prostate. In anterior lobe Urethral striated muscle distribution trend near the tip of the prostate increased, and into the direction of the urethral cavity into. Conclusion: Transurethral resection of prostate should not be too much cutting the anterior leaf area to avoid direct injury of the urethral sphincter. This principle is especially important for patients with relatively small prostate volumes and when operating near the tips of the prostatic.