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

目的 　評價術前使用依立雄胺對經(jīng)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(xù)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(yī)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(shù)、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(shù)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(jīng)尿道前列腺切除術中出血的預防作用. 中國循證醫(yī)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(jīng)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(yī)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(yī)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. 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. 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. 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. 4. Zhang XL, Cui M. Epristeride. Chinese Journal of New Drugs, 2001, 10(1): 64.
  5. 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. 6. Chapter 1: diagnosis and treatment recommendations. J Urol, 2003, 170 (2 Pt 1): 530-547.
  7. 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. 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. 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. 10. 李恭會, 何正富, 余大敏, 等. 非那雄胺對經(jīng)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(yī)學版）,2004, 33(3): 258-260.
  11. 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. 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. 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. 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. 15. 張鮮利, 崔敏. 依立雄胺片. 中國新藥雜志,2001, 10(1): 64.
  16. 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. 17. AUA practice guidelines committee. AUA guideline on management of benign prostatic hyperp lasia (2003) .
  18. 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. 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. 20. Foley SJ, Bailey DM. Microvessel density in prostatic hyperplasia. BJU International, 2000, 85(1): 70-73.
  21. 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. 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(yī)學版）, 2002, 33(2): 226-228.
  23. 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.