Kirollos M M, Campbell N
Urology Department, Torbay Hospital, UK.
Br J Urol. 1997 Jul;80(1):111-5. doi: 10.1046/j.1464-410x.1997.00253.x.
To assess the blood loss accompanying TURP and investigate its association with the resected weight of prostatic tissue, type of anaesthesia, type of presentation, histology, different surgeons and their differing techniques, and thus to reduce the morbidity associated with blood loss and transfusion.
All prostatectomies carried out in a district general hospital were audited prospectively, recording the pre- and post-operative haemoglobin concentration (Hb), blood transfusions and the variables listed above. The audit was repeated a year later.
The peri-operative blood loss, as assessed by various indicators, was equivalent to a decrease in Hb of 10-15 g/L (8-11%). The weight of the resected prostatic tissue was the most important measurable factor in determining blood loss. Regional anaesthesia was associated with less blood loss than general anaesthesia. The added use of a suprapubic catheter for irrigation appeared to have a marginal advantage in large resections. The type of presentation, elective or otherwise, and the histological nature of the prostate did not influence blood loss. Smaller transfusions were probably avoidable in patients having smaller resections and a normal pre-operative Hb. On re-auditing, the overall transfusion rate was reduced from 10.8% to 8.2% and from 4.4% to 1% in patients having resections of < 30 g.
Blood transfusion can be reduced and rationalized. Patients with a normal pre-operative Hb and undergoing resections of < 30 g do not usually require transfusion. Regional anaesthesia is associated with less blood loss but its advantage is overshadowed in practice by the weight of the resected tissue. An audit of this type is repeatable and is useful in raising awareness, objectively assessing differences and advocating and assessing any changes made.
评估经尿道前列腺切除术（TURP）术中的失血量，并研究其与前列腺组织切除重量、麻醉类型、临床表现类型、组织学、不同外科医生及其不同技术之间的关系，从而降低与失血和输血相关的发病率。
对一家地区综合医院进行的所有前列腺切除术进行前瞻性审计，记录术前和术后血红蛋白浓度（Hb）、输血情况以及上述变量。一年后重复该审计。
通过各种指标评估，围手术期失血量相当于Hb下降10 - 15 g/L（8 - 11%）。切除的前列腺组织重量是决定失血量的最重要可测量因素。区域麻醉比全身麻醉导致的失血量少。在大切除术中，额外使用耻骨上导管进行冲洗似乎有微小优势。临床表现类型（择期与否）和前列腺的组织学性质不影响失血量。对于切除量较小且术前Hb正常的患者，较小剂量的输血可能是可避免的。再次审计时，切除量<30 g的患者总体输血率从10.8%降至8.2%，从4.4%降至1%。
输血可以减少并合理化。术前Hb正常且切除量<30 g的患者通常不需要输血。区域麻醉与较少的失血量相关，但在实际中其优势被切除组织的重量所掩盖。这种类型的审计是可重复的，有助于提高认识、客观评估差异以及倡导和评估所做的任何改变。
