前列腺穿刺活检术后并发症的相关因素分析：多中心回顾性研究  

Complications of prostate biopsy and its risk factors： a retrospective multicenter study

作　　者：刘秉乾[1] 梁宏[1] 张国兵[1] 王义昆[1] 武玉东[1] 范志强[2] 冯超杰 胡建庭[4] 张昊[5] 潘周辉[6] 王智勇[1] 刘新奎[2] 王玲[7] 李鑫[8] 魏金星[1] 

机构地区：[1]郑州大学第一附属医院泌尿外科,450052 [2]郑州大学人民医院泌尿外科 [3]郑州大学附属肿瘤医院泌尿外科 [4]郑州人民医院泌尿外科 [5]郑州大学中心医院泌尿外科 [6]郑州大学第三附属医院泌尿外科 [7]郑州大学第一附属医院放疗科,450052 [8]郑州大学第一附属医院肿瘤科,450052

出　　处：《中华泌尿外科杂志》2014年第9期676-680,共5页Chinese Journal of Urology

基　　金：国家自然科学基金（30801151）

摘　　要：目的 分析前列腺穿刺活检术后相关并发症的情况及其相关危险因素. 方法 回顾性分析2002年1月至2011年12月收治的1 959例接受经直肠前列腺穿刺活检患者的资料.根据预防性应用抗生素的种类将患者分为3组：A组应用喹诺酮类＋甲硝唑,B组应用三代头孢＋甲硝唑,C组应用三代头孢＋β内酰胺酶类药物.A组1 067例,年龄（71.2±10.3）岁,前列腺体积（58.1±17.6） ml,糖尿病199例,全麻下穿刺582例,合并前列腺炎338例,前列腺癌431例;B组451例,年龄（72.4±11.9）岁,前列腺体积（52.3±19.9） ml,糖尿病86例,全麻下穿刺269例,合并前列腺炎147例,前列腺癌157例;C组441例,年龄（68.7±13.2）岁,前列腺体积（49.1± 15.1） ml,糖尿病82例,全麻下穿刺270例,合并前列腺炎148例,前列腺癌193例.统计术后1周内排尿、出血、感染等相关并发症的发生率,采用Logistic回归检验分析前列腺穿刺活检术后并发症的危险因素. 结果 本组1 959例前列腺穿刺活检术后排尿和出血相关并发症的发生率分别约为80.0％和15.0％,发热的发生率为4.5％～ 13.5％.C组发热的发生率（0.9％）低于B组（5.1％）和A组（12.0％）,差异均有统计学意义（P＜0.05）.糖尿病患者发热的发生率（10.9％）高于无糖尿病者（7.2％）,前列腺炎患者发热的发生率（10.1％）高于无前列腺炎者（6.9％）,差异均有统计学意义（P＜0.05）.Logistic回归检验结果显示糖尿病（OR=1.679）、前列腺炎（OR=1.495）、抗生素方案（OR=0.746）是前列腺穿刺活检术后发热的独立危险因素（P均＜0.05）,而发热与前列腺体积、患者年龄、穿刺针数、麻醉方式以及病理结果无关（P均＞0.05）. 结论 前列腺穿刺活检术前控制糖尿病和前列腺炎,并根据本地区细菌耐药监测结果选择抗生素短期应用可降低术后感染的发生率.Objective To evaluate the prevalence of prostate biopsy complications and identify its risk factors.Methods Clinical data of 1959 patients underwent prostate biopsy between Jan.2002 and Dec.2011 were retrospectively analyzed.These patients were divided into three groups according to different prophylactic antibiotics （Group A：quinolone＋metronidazole; Group B：third generation cephalosporin＋metronidazole; Group C：third generation cephalosporin＋ beta lactamases）.Baseline data and complications within 1 week following prostate biopsy were collected.The Logistic regression analysis were used for data analysis.Results Between 2002 and 2011,the rates of voiding and bleeding related complications of prostate biopsy were 80% and15%,but the fever rates were 4.5%-13.5%.After prostate biopsy,the fever rate of group C was lower compared with group B and A （0.9% vs.5.1% vs.12.0%,P〈0.05）,the fever rate of diabetic was higher than that without diabetes （10.9% vs.7.2%,P〈0.05）,the fever rate of patient with prostatitis was higher than that without prostatitis （10.1% vs.6.9%,P）.The fever after prostate biopsy was associated with diabetes,prostatitis and different antibiotics （OR =1.679,1.495,0.746; all P〈0.05）,but was not related to prostate size,age,biopsy cores,anesthesia and pathology results （P 〉 0.05）.Conclusions Preoperative management of diabetes mellitus and prostatitis,and short-term application of antibiotics according to local bacterial resistance surveillance results can decrease the incidence of fever after prostate biopsy.

关 键 词：前列腺 活组织检查 针吸 并发症 预防 

分 类 号：R697.3[医药卫生—泌尿科学]