摘要
目的探讨超声引导下经会阴前列腺穿刺置管引流联合抗菌药物灌洗在前列腺脓肿治疗中的可行性及疗效。方法回顾性分析10例经多参数MRI、经直肠超声检查(TRUS)或CT确诊的前列腺脓肿患者病历资料。所有患者均在局麻下行超声引导下经会阴前列腺穿刺置管,脓液行培养,甲硝唑庆大霉素反复冲洗脓腔,并根据药敏结果调整抗生素。记录术中首次抽取脓液量,手术时间,以及引流管和尿管留置时间,相关并发症情况。术后行血常规、尿常规。结果 10例患者全部一次穿刺成功,吸出脓液15~25 mL。手术时间20~42 min,平均30.2 min。术后引流管留置4~9天,平均6.5天。术后尿管留置7~15天,平均9.8天。4例术后发生血尿,3~5日后症状消失,2例留置管次日发生堵塞,经用0.9%氯化钠注射液冲洗管腔并稀释脓液后引流管通畅。10例均治愈,且对其随访3~12个月,未见复发及相关并发症。手术前后血常规、尿常规中白细胞差异均有统计学意义(P<0.01)。结论超声引导下经会阴前列腺穿刺置管引流联合抗菌药物灌洗治疗前列腺脓肿,可使脓腔局部维持高浓度的抗生素,不仅能通畅引流,避免病人重复穿刺的痛苦,且该方法操作简便,值得临床推广。
Objective o evaluate the feasibility and efficacy of ultrasound-guided drainage with transperineal percutaneous catheterization in combination with antimicrobial lavage as a technique for the treatment of prostate abscess. Methods Firstly, the clinical data of 10 patients diagnosed as cases of prostate abscess by multi-parameter MRI, TRUS, or CT were subjected to retrospective review. All subjects were treated with local anesthesia and subjected to ultra-sound guided transperineal percutaneous prostate catheterization. Samples of pus from the abscess were collected for bacterial cultivation. Repeated lavage with metronidazole and gentamicin was conducted on the location of abscess to clear the pus. In accordance with the feedback from drug sensitivity, the use of antibiotics was adjusted. The amount of pus collected on the very first time in the process of surgery, the length of operation time, the length of drainage catheterization and that of urinal catheterization, and cases of complications were documented. Routine blood tests and routine urine tests were performed after surgery. Results All ten cavities of puswere punctured successfully at the very first attempt and 15 to 25 mL of sticky pus on the average were drawn out of each cavity. The length of operation time on the ten cavities ranged from 20 minutes to 40 minutes, 30.2 minutes on average. The length of drainage catheterization after surgery to the ten cavities ranged from 4 days to 9 days, 6.5 days on the average. The length of urinal catheterization after surgery ranged from 7 to 15 days, 9.8 days on the average. Hematuresis was found of 4 patients after operation. The symptoms disappeared in 3~5 days after the incidence. Blockage was found in two catheters in the following day after catheterization. The obstruction was cleared after the pus had been diluted and the cavities had been washed with 0.9% sodium chloride injection. All 10 cases were cured. Follows-up were conducted in the following 3 to 12 months and did not witness any recurrence or related complications. The differences between the number of white blood cells as observed in the routine blood tests and routine urine tests before surgery and that as observed after surgery were statistically significant(P<0.01). Conclusions Ultrasound-guided drainage with transperineal percutaneous transcatheterization in combination with antibacterial lavage as a technique for the treatment of prostate abscess guarantees a high concentration of antibiotics in the cavity, which not only permits unblocked drainage but also greatly alleviates the pain which the patients suffer due to repeated actions of puncture. It is easy to operate and thus can serve as a desirable technique for clinical application.
作者
樊闯
裴媛
董田明
韩国辉
陈曦
康绍叁
FAN Chuang;PEI Yuan;DONG Tianming;HAN Guohui;CHEN Xi;KANG Shaosan(Department of Urology,the Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,China)
出处
《健康研究》
CAS
2019年第6期673-677,682,共6页
Health Research
基金
河北省科技惠民工程——重点研发计划自筹项目(162777145)
河北省三三三人才工程项目(A2017002087)
