Surveillance study of irrigating fluid absorption and bleeding in transurethral resection of the prostate / 中华泌尿外科杂志

Objective To investigate the effect of the endoscopic surveillance system in irrigating fluid absorption and bleeding during transurethral resection of the prostate.Methods In vitro trials,we simulated the fluid absorption and bleeding in the operation by using self-developed endoscopic surveillance system from January 2013 to June 2013.Continuous irrigation of 5 ％ mannitol solution,we extracted 5 times irrigating fluid (each time 100 ml and a total of 500 ml) in the process of irrigation and recorded absorption measurements of every time extraction rinses.At the same time,we dripped human whole blood 5 times(each time 5 ml and a total of 25 ml) in the process of irrigation and recorded the bleeding measurements.The above process was repeated three times to detect the accuracy and consistency of the endoscopic surveillance system.In clinical trials,50 cases of BPH were monitored in surgery and the biochemical index,hemodynamics,irrigating fluid absorption and bleeding were compared from October 2016 to April 2017.The included criteria contained as follow:the age of patients should be more than 50 years.The transabdominal ultrasound showed that the volume of prostate should be more than 60 ml.The maximal uroflowmetry should be less than 15ml/s.The IPSS scores should be more than 8.Based on the operative time,two groups (＜60 min and ≥ 60 min) were classified.Results We developed the endoscopic surveillance system which is original in the world.In vitro trials,the average irrigating fluid were (100.60 ± 2.07) ml,(201.00±3.39) ml,(302.00±4.67) ml,(403.60±4.39) ml and (502.40 ±7.57) ml;and the average bleeding were (5.06 ± 0.11) ml,(10.10 ± 0.16) ml,(15.04 ± 0.15) ml,(20.06 ± 0.11) ml and (25.10 ± 0.16) ml.No significant difference was observed in all groups (P ＞ 0.05).In clinical trials,we compared some preoperative and postoperative indexes.The average blood oxygen saturation were (94.46 ± 2.49) ％ and (92.39 ± 2.77) ％ (P ＜ 0.01),the average Serum sodium ion concentration were (141.05 ± 2.52) mmol/L and (138.06 ± 4.27) mmol/L(P ＜ 0.01),the average HGB were (143.50 ± 13.43) g/L and (137.04 ± 14.25) g/L(P ＜ 0.01).The average HCT were (42.05 ± 4.09) ％ and (137.04 ± 14.25) ％ (P ＜ 0.01).The average HR were (77.9 ± 7.6) beats per minute and (77.93 ± 6.93) beats per minute (P＞0.05).The MAP were (90.32 ± 9.75) mmHg and (91.07±8.96)mmHg(P＞0.05).The average serum potassium ion concentration were (4.13 ± 0.53) mmol/L and (4.09 ± 0.37) mmol/L (P ＞ 0.05).The average irrigating fluid absorption of the group less than 60 minutes and the group equal or more than 60 minutes were (401.83 ± 279.23) ml and (885.25 ± 367.68) ml (P ＜ 0.01).The average blood loss were (64.10 ±47.47) ml and (158.40 ± 65.22) ml(P ＜0.01).The preoperative and postoperative hemodynamic,blood biochemical and hematology showed difference in our trials.Irrigating fluid absorption and blood loss were positively associated with operation time.Conclusions The endoscopic surveillance system was safety and accuracy.It can offer real-time monitoring data and alarm mechanism for the surgeons that possibly improve operation safety.

Latest Progress of Intraoperative Pleural Lavage Cytology in Lung Cancer Surgery / 中国肺癌杂志

Intraoperative pleural lavage cytology is a diagnostic technique used to detect tumor cells and serve as a prognostic parameter for non-small cell lung cancer (NSCLC) patients. In the past several decades, many scholars have been dedicated to clarifying the relationships between positive intraoperative pleural lavage cytology results and postoperative survival as well as tumor recurrence and metastasis. However, the findings remained various due to the inhomogeneity of different research. It has been confirmed that a positive intraoperative pleural lavage cytology result is one of the risk factors for the prognosis of postoperative patients. This study reviewed the advances in research of intraoperative pleural lavage cytology in recent years from several aspects, including clinical significance, influencing factors and possible mechanisms.
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Effect of irrigating fluid temperature on core body temperature during Transurethral resection of the prostate.

The objective of this study was to determine the effect of irrigating fluid temperature on core body temperature changes in patients undergoing transurethral resection of the prostate (TURP). A cross sectional study was conducted on 32 patients with benign prostatic hyperplasia (BPH) who underwent TURP at our institution between September 2003 and January 2004. Patients were randomized to one of two groups. Standard group consisted of 16 patients who received room temperature irrigating fluid (± 23.6 0C) throughout TURP. Isothermic group consisted of 16 patients whose procedure was performed using warmed irrigating fluid (± 37.2 0C). The irrigating fluid used for both groups was aquabidest. The age, resection time, weight of resected prostate, amount of irrigating fluid used, temperature in the operating theatre, core body temperature at beginning and at conclusion of TURP were recorded for each patient. The t test was used for comparison between both groups and a p value of 0.05 or less was considered significant. The result of this study showed a decrease of core body temperature during TURP, using either room temperature or warmed irrigating fluid (both p = 0.000). None of the patients in either group demonstrated any criteria of hypothermia. The average decrease of core body temperature in standard group (0.99 0C) was greater than in isothermic group (0.75 0C), but it was not significantly different (p > 0.05). In conclusion, our study revealed that using either room temperature irrigating fluid or warmed irrigating fluid during TURP could decrease core body temperature at approximately similar level, with no incidence of hypothermia.

Determination and its significance of the amount of irrigating fluid absorbed during TURP by use of plasma sorbitol concentration / 대한비뇨기과학회지

The main problems of transurethral prostatectomy were intraoperative blood loss and absorption or irrigating fluid. The reduced serum sodium concentration and osmolality. regarded as cause of TURP syndrome. was caused by dilution by several liters of irrigating fluid. Early recognition. while surgery is being performed is important to prevent development of hypovolemia. especially in the aged group. From January 1990 to June 1990. prospective study for the determination of the amount of irrigating fluid absorbed by use of plasma sorbitol concentration, serum electrolytes change and other related factors was undertaken in 30 patients undergoing TURP with manufactured URIONE solution (sorbitol 2.7 gm+mannitol 0.54 gm/100 ml distilled water) as irrigating fluid. An accurate measurement of plasma sorbitol concentration absorbed was obtained by Beutler`s enzymatic sorbitol analysis. Statistical evaluation of all data obtained was made using the `t-test` with significance at 0.1 percent or less. Mean plasma sorbitol concentration absorbed, blood loss. absorbed irrigating fluid volume were 474.2+/-344.3 mg/1.216 ml and 554.3+/-300.2 ml, respectively. A statistically significant positive interrelationship was found among absorbed plasma sorbitol concentration, serum sodium change and absorbed irrigating fluid volume (p<0.001). Also significant correlations could be obtained between absorbed irrigating fluid volume and serum sodium change (p<0.001).

The Relation between the Hyponatremia and the Amount of Irrigation Fluid during Transurethral Resection of Prostate / 대한마취과학회지

We know that irrigating fluid used during transurethral resection of prostate (TURP) is rapidly absorbed through open prostatic venous channels in large amount. The TURP syndrome is symptom complex of hypervolemia & hyponatremia (below 130 mEq/1) due to absorption of irrigating fluid. We studied the change of serum sodium, potassium and symptom of hypervolemia during the perioperative period, in 35 patients undergoning TURP. The aim of this clinical study was to examine the possible relation between the irrigating fluid absorption & the development of hyponatremia after TURP. The results were as follow. 1) Though p value was not acceptable, there waa numerical correlation between the weight of resected prostate and the amount of irrigating fluid. 2) TURP syndrome and severe sodium change were not reported in our studiea, 3) We through the cause of above results that operation time & minimal use of irrigating fluid & minimal bleeding due to advanced operative technique, adequate fluid therapy, and intenaive monitoring of vital sign & physiologic change of patients.

A Study of Blood Loss and Change of Serum Electrolytes During Transurethral Prostatic Resection / 대한비뇨기과학회지

The main problems of transurethral prostatectomy were operative blood loss and absorption of irrigating fluid. Blood loss is a significant factor in the morbidity and mortality of prostatic surgery. Early recognition while surgery is being performed is important to prevent development of hypovolemia, especially in the aged group. The reduced serum sodium and osmolarity concentration, regarded as cause of TURP syndrome, was caused by dilution by several liters of irrigating fluid. To better understand the hemodynamic changes occurring in patients undergoing transurethral prostatectomy, from January 1989 to July 1989, a program for prospective study of blood loss measurement, serum electrolytes change and other related factors was undertaken in 21 patients undergoing TURP by use of manufactured URIONE solution(Sorbitol 2.7gm + Mannitol 0.54gm/ 100ml distilled water) solution as irrigating fluid. An accurate measurement of blood was obtained by Hemoglobincyanide method, a colorimetric determination of hemoglobin in the irrigating fluid. Statistical evaluation of all data obtained was made using the "t test" with significance at 6 percent or less. There was a significant postoperative decrease in serum sodium and osmolality concentration, respectively averaging 3.7 +/- 3.8mEq/1, 8.4 +/- 8.1mOsm/kg. They were not correlated with absorbed irrigant fluid volume, resection time, weight of tissue resected( P>0.05). Blood loss ranged from 18 to 1250ml and its mean was 178ml. A statistically significant positive interrelationship was found among operative blood loss, resection time, irrigating fluid volume. Also significant correlation could be gained between absorbed irrigant fluid volume and serum sodium change(P<0.05 ), and resection weight and irrigation fluid volume(P<0.05).