恥骨後前立腺摘出術における術中・術後出血へ影響を及ぼす因子について

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The various factors affecting the amount of bleeding at prostatectomy was analysed concerning to the local status of the prostate as well as the postoperative fibrinolytic site. The amount of bleeding was estimated by weight method for the bleeding during the operation and by Gatsch-Little's method for the postoperative bleeding. The fibrinolytic activity was measured by fibrin plate method on citrated plasma, euglobulin fraction of the plasma, and fresh urine. 1) Local status of the prostate and bleeding The most heavy bleeding during surgical operation was found in the cases with hen's egg-sized prostate, as well as in the cases with severe adhesion between the adenoma and the surgical capsule of the prostate. On the other hand, the most large amount of postoperative bleeding was found in the cases with hen's egg-sized prostate, as well as in the cases with the adenoma over 41 g in its weight and without any adhesion. 2) Fibrinolytic activity and bleeding There could not be found any relation between the fibrinolytic activity of peripheral blood and the amount of postoperative bleeding. However, in the cases in whom urokinase were inhibited, rather less bleeding in the urine was found. With the results obtained above, following facts were clarified. First, the factors which affect on the amount of operative and postoperative bleeding would be classified into the prostate bed, and hematological elements. As to the surgical procedure, the time-saving to ablate the adenoma and to suture the surgical capsule of the prostate should be required to reduce the operative bleeding. Hemostatic procedure during the surgery would be very important to decrease the postoperative bleeding. Attention should be paid to the nature of the prostatic bed mainly to the amount of postoperative bleeding, and in this case the size of the prostatic bed would be an important factor. And furthermore, it was assumed that the fibrinolytic activity, one of the hematological factors, would be represented as the local process at the prostatic bed, and the general process of it appeared in the whole blood would affect the postoperative bleeding secondarily.
社団法人日本泌尿器科学会の論文

恥骨後前立腺摘出術における術中・術後出血へ影響を及ぼす因子について

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