Nghiên cứu ảnh hưởng của dịch rửa sorbitol 3% hoặc natriclorid 0,9% trên một số chỉ số xét nghiệm trong phẫu thuật nội soi cắt tuyến tiền liệt qua niệu đạo tt tiếng anh

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF DEFENCE THE INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES 108 NGUYEN VAN DANG STUDY ON THE EFFECT OF 3% SORBITOL IRRIGATING SOLUTION OR 0.9% SODIUM CHLORIDE SOLUTION ON SOME TEST INDICATORS IN THE TRANSURETHRAL RESECTION OF THE PROSTATE Specialty Code : Anesthesia - Resuscitation : 62.72.01.22 Summary of Medical Doctor of Phylosophy Thesis HA NOI - 2019 The work was completed in The Institute of Clinical Medical and Pharmaceutical Sciences 108 Scientific supervisor: Hoang Van Chuong, PhD Assoc Prof Nguyen Phu Viet, PhD Commentor 1: Commentor 2: Commentor 3: The thesis will be defended in front of the Institute's Thesis Evaluation Council in… ,2019 Address: The Institute of Clinical Medical and Pharmaceutical Sciences 108 The thesis can be found at libraries: - National Library - Library of The Institute of Clinical Medical and Pharmaceutical Sciences 108 INTRODUCTION Currently, transurethral resection of the prostate (TURP) is still the reference standard for surgical treatments for lower urinary tract disorders due to benign prostatic hyperplasia (BPH) The surgical procedure is associated with continuous irrigating solution Absorption of irrigating solution into the circulatory system alters the volume of body fluids along with the homeostatic index Types of irrigating solution used include sterile water, solutes-containing solutions and irrigating solutions containing electrolytes Since 2012, TURP with bipolar electric knife with 0.9% NaCl irrigating solution has been applied in our country 0.9% NaCl solution is an intravenous infusion However, the irrigation environment during prostate endoscopy is different from intravenous infusion and so how does the irrigating solution 0.9% sodium chloride affect the concentration of substances in the blood? Is the impact of 0.9% sodium chloride irrigating solution common in Vietnam on TURP? Therefore, we implemented the topic "Studying the effects of irrigating solution 3% sorbitol or 0.9% sodium chloride on some test indicators in transurethral resection of the prostate" with the goal: 1- Evaluation of changes in electrolytes, osmotic pressure, glucose and hemoglobin in patients undergoing transurethral resection of the prostate (TURP) surgery using irrigating solution 3% sorbitol or 0.9% sodium chloride 2- Comment on some clinical features and related factors in patients with changing test indicators • Scientific and practical significance of the thesis The first Irrigating solution used in PROSTATE endoscopy is sterile water but is very hypotonic (ALTT = 0) and causes many serious complications such as hemolysis, transurethral resection (TUR) syndrome Then many types of non-electrolyte irrigating solutions such as glycine, mannitol, sorbitol replace sterile water, causing less hemolysis but not eliminating hyponatremia and transurethral resection (TUR) syndrome The thesis is a scientific work confirming the effectiveness and safety of 0.9% natri chloride irrigating solution is the elimination of diluted hyponatremia and transurethral resection (TUR) syndrome in PROSTATE endoscopy • New contributions of the thesis The dissertation contributes to compare the effect of types of irrigating solution 3% sorbitol or 0.9% NaCl on some test indicators of patients undergoing transurethral resection of prostate and confirming hyponatremia associated with transurethral resection (TUR) syndrome with manifestations clinical still occurs when using 3% sorbitol irrigating solution, while clarifying some factors related to dilution of hyponatremia and clinical manifestations The study results showed that using 0.9% NaCl solution in transurethral resection of prostate is safer than the 3% sorbitol solution, excluding the dilution of hyponatremia and transurethral resection (TUR) syndrome • Layout of the thesis - The thesis has 124 pages, including sections: problem statement (2 pages), overview (36 pages), subjects and research methods (19 pages), research results (25 pages), discussion (39 pages), conclusions (2 pages), recommendations (1 page) - The thesis has 31 tables, 19 pictures, charts and 159 references (Vietnamese and English) CHAPTER OVERVIEW 1.1 Benign prostatic hyperplasia 1.1.1 Concept Benign prostatic hyperplasia (BPH) is a proliferation of prostate tissues, mainly the fibrous, muscle and gland organizations in the early aging The condition causes prostatic enlargement, change in size and can cause urinary disorders 1.1.2 A summary of the anatomical and neurological position that governs the prostate gland 1.1.3 Pathogenesis 1.1.4 The definitive diagnosis of benign prostatic hyperplasia 1.1.6 Principles of treatment of benign prostatic hyperplasia 1.2 Transurethral resection of prostate methods 1.2.1 Transurethral resection of prostate (TURP) indications 1.2.2 Transurethral resection of prostate contra-indications 1.2.3 Transurethral resection of prostate (TURP) instruments and devices 1.2.3.1 Resector Resector is connected to a monopolar or bipolar high power source and is integrated with a coaxial continuous flow irrigation system Figure 1.5 Monopolar-resector Figure 1.6 Bipolar-resector 1.2.3.2 Machines for transurethral resection of prostate 1.2.3.3 Disadvantages of unipolar current and bipolar current in TURP * Disadvantages of using unipolar current in transurethral resection of prostate * Disadvantages of using bipolar current in transurethral resection of prostate 1.2.4 Types of irrigating solution in transurethral resection of prostate 1.2.4.1 Sterile water solution 1.2.4.2 Irrigating solution containing glycine 1.2.4.3 Irrigating solution containing mannitol (C6H11O6) 1.2.4.4 Irrigating solution containing sorbitol 1.2.4.5 Using an irrigating solution containing 5% glucose 1.2.4.6 Ringer lactate solution 1.2.4.7 0.9% isotonic saline 1.2.5 Anesthesia method for TURP 1.2.5.1 Methods of general anesthesia 1.2.5.2 Methods of regional anesthetic 1.2.5.2.1 Spinal anesthesia (GTTS) 1.2.5.2.2 Method of epidural anesthesia 1.2.5.2.3 Coccygeal anesthesia method 1.2.5.3 Methods of local anesthesia 1.2.6 Harmful events and complications of transurethral resection of prostate 1.2.6.1 Systemic complications 1.2.6.2 Bleeding complications 1.2.6.3 Infectious complications 1.2.6.4 Irrigating solution absorption syndrome (TURP syndrome) TURP must use an irrigating solution The commonly used irrigating solution does not contain electrolytes, hypotonic, the washing pressure is usually higher than the venous blood pressure and the irrigating solution flows through the vascular opening in the circulation, or penetrates through the cut area into the cavity around the bladder causes volume change of body fluids, hyponatremia due to dilution closely resembles water intoxication These phenomena combine with the pharmacological effects of solutes to form an irrigating solution, also known as transurethral resection (TUR) syndrome 1.2.6.4.1 Signs and symptoms of irrigating solution absorption syndrome • General symptoms •The relationship between symptoms and blood sodium concentration •Some clinical symptoms are specific to the type of irrigating solution 1.2.6.4.2 Treatment of irrigating solution absorption syndrome * General treatment measures * The special treatment - Hyponatremia has clinical symptoms, no fluid overload, no heart failure, kidney failure and pulmonary edema Treat blood Na +