術前使用依立雄胺對經尿道前列腺切除術中出血的預防作用_《中國循證醫學雜志》

作者：

鄧華 ¹ ,  魏強 ¹ , 李濤 ² , 袁仁斌 ³ , 李奇峻 ¹

1. 四川大學華西醫院泌尿外科（成都 610041） 2. 四川大學華西第二醫院產科 3. 成都市第三人民醫院泌尿外科;

關鍵詞：

依立雄經尿道前列腺切除術良性前列腺增生出血

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目的　評價術前使用依立雄胺對經尿道前列腺切除術 (transurethral resection of prostate，TURP)術中出血的影響并探討其作用機理。
方法　將擬行TURP的良性前列腺增生患者分為兩組，試驗組30例術前服用依立雄胺連續7~11天，每次5 mg，一天兩次；對照組30例采用空白對照。所有手術由同一組醫師實施,逐一記錄手術時間、術中切除前列腺組織重量及術中沖洗液量；計算術中出血總量、出血指數、出血強度。免疫組織化學SP法測定前列腺組織中微血管密度、血管內皮生長因子、內皮型一氧化氮合酶的表達。
結果　試驗組和對照組術中平均出血總量分別為179.51±78.29 ml和237.95±124.38 ml（P lt;0.05），平均出血指數分別為7.68±3.94 ml/g和 9.73±3.42 ml/g（P lt;0.05），平均出血強度分別為2.43±1.03 ml/min和3.30±1.50 ml/min（P lt;0.05）；前列腺組織微血管密度值分別為18.80±5.68和23.70±4.91（P lt;0.05），血管內皮生長因子表達評分平均秩和分別為23.48和31.77（P lt;0.05），內皮型一氧化氮合酶表達評分平均秩和分別為22.90和32.25（P lt;0.05）。
結論　術前使用依立雄胺能有效減少TURP術中出血, 其機制可能與抑制了增生前列腺組織中的血管生成有關。

引用本文： 鄧華,魏強,李濤,袁仁斌,李奇峻. 術前使用依立雄胺對經尿道前列腺切除術中出血的預防作用. 中國循證醫學雜志, 2007, 07(6): 415-419. doi: 復制

1.	Liu XD, Yang YR, Lu YP, et al. Preoperative finasteride on decreasing operative bleeding during transurethral resection of prostate. Chinese Journal of Urology, 2003, 24(10): 694-696.
2.	Liu JJ, Cao J, Xu ZJ, et al. The effect of finasteride on bleeding associated with suprapubic prostatectomy and transurethral resection of prostate. Chinese Journal of Urology, 2001, 22(8): 490-492.
3.	Gu XQ, Ma QJ, Kong XB, et al. The effect of finasteride on VEGF and microvascular density in prostatic tissues. Chinese Journal of Gerontology, 2002, 22(4): 255-256.
4.	Zhang XL, Cui M. Epristeride. Chinese Journal of New Drugs, 2001, 10(1): 64.
5.	Xue ZY, Han WK, Jin J, et al. A multicentre clinical trail on epristeride for treatment of benign prostate hyperplasia. The Chinese Journal of Clinical Pharmacology, 2000, 16(6): 432-435.
6.	Chapter 1: diagnosis and treatment recommendations. J Urol, 2003, 170 (2 Pt 1): 530-547.
7.	Liu XD, Dong Q, Lu YP, et al. Effects of testosterone on VEGF and FLK-1 protein in expression in the ventral prostate of rat. Journal of Sichuan University (Medical Science Edition), 2002, 33(2): 226-228.
8.	Li GH, He ZF, Yu DM, et al. Effect of finasteride on intraoperative bleeding and irrigating fluid absorption during transurethral resection of prostate: a quantitative study. Journal of Zhejiang University(Medical Sciences), 2004, 33(3): 258-260.
9.	Donohue JF, Sharma H, Abraham R, et al. Transurethral prostate resection and bleeding: a randomized, placebo controlled trial of role of finasteride for decreasing operative blood loss. J Urol,2002,168(5): 2024-2026.
10.	李恭會, 何正富, 余大敏, 等. 非那雄胺對經尿道前列腺切除術中出血和沖洗液吸收影響的定量性研究. 浙江大學學報（醫學版）,2004, 33(3): 258-260.
11.	Donohue JF, Hayne D, Karnik U, et al. Randomized, placebo-controlled trial showing that finasteride reduces prostatic vascularity rapidly within 2 weeks. BJU International, 2005, 96(9): 1319-1322.
12.	劉孝東, 楊宇如, 盧一平, 等. 非那雄胺減少TURP術中出血的機理研究.中華泌尿外科雜志, 2003,24(10): 694-696.
13.	柳建軍, 曹軍, 許志堅, 等. 非那雄胺對前列腺增生癥術中及術后出血的治療作用. 中華泌尿外科雜志, 2001, 22(8): 490-492.
14.	谷欣權, 馬慶杰, 孔祥波, 等. 非那雄胺對前列腺血管內皮生長因子與微血管的影響. 中國老年學雜志, 2002,22(4): 255-256.
15.	張鮮利, 崔敏. 依立雄胺片. 中國新藥雜志,2001, 10(1): 64.
16.	薛兆英, 韓文科, 金杰, 等. 愛普列特治療良性前列腺增生Ⅱ期臨床研究.中國臨床藥理學雜志, 2000, 16(6): 432-435.
17.	AUA practice guidelines committee. AUA guideline on management of benign prostatic hyperp lasia (2003) .
18.	Puchner PJ, Miller MI. The effects of finasteride on hematuria associated with benign prostatic hyperplasia: a preliminary report. J Urol,1995,154(5): 1779-1782.
19.	Lekas E, Bergh A, Damber JE. Effects of finasteride and bicalutamide on prostatic blood flow in the rat. BJU International, 2000, 85(7): 962-965.
20.	Foley SJ, Bailey DM. Microvessel density in prostatic hyperplasia. BJU International, 2000, 85(1): 70-73.
21.	Dulak J, Jozkowicz A, Dembinska-Kiec A, et al. Nitric oxide induces the synthesis of vascular endothelial growth factor by rat vascular smooth muscle cells. Arteriosclerosis, Thrombosis & Vascular Biology, 2000, 20(3): 659-666.
22.	劉孝東, 董強, 盧一平, 等. 睪酮對血管內皮生長因子及其受體在大鼠前列腺組織中表達的影響. 四川大學學報（醫學版）, 2002, 33(2): 226-228.
23.	Hayek OR, Shabsigh A, Kaplan SA, et al. Castration induces acute vasoconstriction of blood vessels in the rat prostate concomitant with a reduction of prostatic nitric oxide synthase activity. J Urol, 1999, 162(4): 1527-1531.

1. Liu XD, Yang YR, Lu YP, et al. Preoperative finasteride on decreasing operative bleeding during transurethral resection of prostate. Chinese Journal of Urology, 2003, 24(10): 694-696.
2. Liu JJ, Cao J, Xu ZJ, et al. The effect of finasteride on bleeding associated with suprapubic prostatectomy and transurethral resection of prostate. Chinese Journal of Urology, 2001, 22(8): 490-492.
3. Gu XQ, Ma QJ, Kong XB, et al. The effect of finasteride on VEGF and microvascular density in prostatic tissues. Chinese Journal of Gerontology, 2002, 22(4): 255-256.
4. Zhang XL, Cui M. Epristeride. Chinese Journal of New Drugs, 2001, 10(1): 64.
5. Xue ZY, Han WK, Jin J, et al. A multicentre clinical trail on epristeride for treatment of benign prostate hyperplasia. The Chinese Journal of Clinical Pharmacology, 2000, 16(6): 432-435.
6. Chapter 1: diagnosis and treatment recommendations. J Urol, 2003, 170 (2 Pt 1): 530-547.
7. Liu XD, Dong Q, Lu YP, et al. Effects of testosterone on VEGF and FLK-1 protein in expression in the ventral prostate of rat. Journal of Sichuan University (Medical Science Edition), 2002, 33(2): 226-228.
8. Li GH, He ZF, Yu DM, et al. Effect of finasteride on intraoperative bleeding and irrigating fluid absorption during transurethral resection of prostate: a quantitative study. Journal of Zhejiang University(Medical Sciences), 2004, 33(3): 258-260.
9. Donohue JF, Sharma H, Abraham R, et al. Transurethral prostate resection and bleeding: a randomized, placebo controlled trial of role of finasteride for decreasing operative blood loss. J Urol,2002,168(5): 2024-2026.
10. 李恭會, 何正富, 余大敏, 等. 非那雄胺對經尿道前列腺切除術中出血和沖洗液吸收影響的定量性研究. 浙江大學學報（醫學版）,2004, 33(3): 258-260.
11. Donohue JF, Hayne D, Karnik U, et al. Randomized, placebo-controlled trial showing that finasteride reduces prostatic vascularity rapidly within 2 weeks. BJU International, 2005, 96(9): 1319-1322.
12. 劉孝東, 楊宇如, 盧一平, 等. 非那雄胺減少TURP術中出血的機理研究.中華泌尿外科雜志, 2003,24(10): 694-696.
13. 柳建軍, 曹軍, 許志堅, 等. 非那雄胺對前列腺增生癥術中及術后出血的治療作用. 中華泌尿外科雜志, 2001, 22(8): 490-492.
14. 谷欣權, 馬慶杰, 孔祥波, 等. 非那雄胺對前列腺血管內皮生長因子與微血管的影響. 中國老年學雜志, 2002,22(4): 255-256.
15. 張鮮利, 崔敏. 依立雄胺片. 中國新藥雜志,2001, 10(1): 64.
16. 薛兆英, 韓文科, 金杰, 等. 愛普列特治療良性前列腺增生Ⅱ期臨床研究.中國臨床藥理學雜志, 2000, 16(6): 432-435.
17. AUA practice guidelines committee. AUA guideline on management of benign prostatic hyperp lasia (2003) .
18. Puchner PJ, Miller MI. The effects of finasteride on hematuria associated with benign prostatic hyperplasia: a preliminary report. J Urol,1995,154(5): 1779-1782.
19. Lekas E, Bergh A, Damber JE. Effects of finasteride and bicalutamide on prostatic blood flow in the rat. BJU International, 2000, 85(7): 962-965.
20. Foley SJ, Bailey DM. Microvessel density in prostatic hyperplasia. BJU International, 2000, 85(1): 70-73.
21. Dulak J, Jozkowicz A, Dembinska-Kiec A, et al. Nitric oxide induces the synthesis of vascular endothelial growth factor by rat vascular smooth muscle cells. Arteriosclerosis, Thrombosis & Vascular Biology, 2000, 20(3): 659-666.
22. 劉孝東, 董強, 盧一平, 等. 睪酮對血管內皮生長因子及其受體在大鼠前列腺組織中表達的影響. 四川大學學報（醫學版）, 2002, 33(2): 226-228.
23. Hayek OR, Shabsigh A, Kaplan SA, et al. Castration induces acute vasoconstriction of blood vessels in the rat prostate concomitant with a reduction of prostatic nitric oxide synthase activity. J Urol, 1999, 162(4): 1527-1531.

《中國循證醫學雜志》

術前使用依立雄胺對經尿道前列腺切除術中出血的預防作用

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《中國循證醫學雜志》

術前使用依立雄胺對經尿道前列腺切除術中出血的預防作用

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