Castellani Daniele, Gasparri Luca, Faloia Lucia, Veccia Diego, Giampieri Marina, Dellabella Marco
Department of Urology, IRCCS INRCA, Ancona, Italy.
Department of Anesthesiology, IRCCS INRCA, Ancona, Italy.
Andrologia. 2021 Feb;53(1):e13807. doi: 10.1111/and.13807. Epub 2020 Sep 2.
Systemic fluid absorption frequently occurs during endoscopic surgery. When large volumes are absorbed, fluid overload is the result. The introduction of lasers allowed the use of normal saline (0.9% sodium chloride) in endoscopic prostatic surgery. This led to the disappearance of the transurethral resection syndrome; however, the fluid overload of normal saline can cause the onset of several catastrophic effects. The present study aimed to evaluate the incidence, sign and symptoms severity of fluid overload in a large series of men who underwent Thulium Laser Enucleation of the Prostate. Between December 2014 and February 2020, 633 men underwent the procedure. Seven patients (1.1%) had symptomatic fluid overload. Two patients developed severe pulmonary oedema, which required oral intubation and admission to the intensive care unit. Two patients required delayed morcellation. The analysis of our series highlighted that old age, large prostate volume, prolonged operative time and prostatic capsular perforation influenced the onset of fluid overload syndrome. Urologists should be aware that fluid overload might be a potentially life-threatening condition and should be early recognised. Surgery should be interrupted as soon as it occurs to avoid severe pulmonary oedema.
内镜手术期间经常会发生全身液体吸收。当大量液体被吸收时，就会导致液体过载。激光的引入使得在内镜前列腺手术中可以使用生理盐水（0.9%氯化钠）。这导致了经尿道切除综合征的消失；然而，生理盐水的液体过载会引发一些灾难性后果。本研究旨在评估接受铥激光前列腺剜除术的大量男性患者中液体过载的发生率、体征和症状严重程度。在2014年12月至2020年2月期间，633名男性接受了该手术。7名患者（1.1%）出现了有症状的液体过载。2名患者发生了严重肺水肿，需要进行气管插管并入住重症监护病房。2名患者需要延迟粉碎术。对我们系列病例的分析突出显示，老年、前列腺体积大、手术时间延长和前列腺包膜穿孔会影响液体过载综合征的发生。泌尿外科医生应意识到液体过载可能是一种潜在的危及生命的情况，应尽早识别。一旦发生，手术应立即中断，以避免严重肺水肿。
