静脉麻醉下经会阴前列腺穿刺活组织检查术日间手术模式的临床应用  

Clinical application of transperineal prostate biopsy under intravenous anesthesia in day surgery

作　　者：董柏君[1] 王艳青[1] 忻志祥 张勇[1] 潘家骅[1] 朱寅杰[1] 薛蔚[1] DONG Baijun;WANG Yanqing;XIN Zhixiang;ZHANG Yong;PAN Jiahua;ZHU Yinjie;XUE Wei(Department of Urology,Renji Hospital. Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院泌尿科,上海200127

出　　处：《上海医学》2019年第3期170-173,共4页Shanghai Medical Journal

基　　金：国家自然科学基金(81572536;81672850;81772742)

摘　　要：目的探讨静脉麻醉下经会阴前列腺穿刺活组织检查术在日间手术模式下开展的安全性和有效性。方法前瞻性收集2014年6月—2019年2月上海交通大学医学院附属仁济医院收治的4 497例连续行静脉麻醉下经会阴前列腺穿刺活组织检查日间手术患者的临床和随访资料。记录手术时间和病理结果,术后第1天随访患者满意度、术后并发症和慢性疼痛发生情况。结果所有患者均顺利完成手术。4 465例于术后3～5 h出院,32例因并发症于次日清晨出院。平均手术时间为(9.6±3.3) min。穿刺阳性率为47.5%,其中前列腺特异性抗原(PSA)<20μg/L的患者的穿刺阳性率为34.4%。患者满意率为99.4%。术后需要急诊处理的并发症发生率为1.4%,其中急性尿潴留34例,尿道严重出血26例,发热4例,经对症处理后均好转。术后24 h内112例患者有会阴部轻微疼痛(疼痛VAS评分1～2分),口服镇痛药后好转。结论静脉麻醉下经会阴前列腺穿刺活组织检查日间手术安全、有效,住院时间短,并发症少,患者满意度高,适合作为常规日间手术推广开展。Objective To investigate the safety and efficacy of transperineal prostate biopsy under intravenous anesthesia in day surgery. Methods From June 2014 to February 2019, clinical and follow-up data of 4 497 patients who underwent transperineal prostate biopsy under intravenous anesthesia in day surgery in our hospital were prospectively collected and analyzed. Operation time and pathological result were recorded. Patients were followed up on day 1 postoperatively to investigate satisfaction, complications and chronic pain. Results All operation cases were completed successfully. A total of 4 465 patients were discharged in 3-5 h after surgery, and 32 patients left hospital in the morning of next day because of postoperative complications. The mean operation time was (9.6±3.3) min. The positive detection rate was 47.5% in all the patients, and 34.4% in those with prostate specific antigen (PSA)<20 μg/L. The satisfaction rate was 99.4%. The incidence of postoperative complications was 1.4%, including acute urinary retention (34 cases), severe urethral bleeding (26 cases) and fever (4 cases). All the complications disappeared after emergency symptomatic treatment. And 112 patients experienced slight perineal pain (visual analog scale score was 1-2) within 24 h after surgery;they recovered after oral analgesics. Conclusion Transperineal prostate biopsy under intravenous anesthesia in day surgery is safe, effective and feasible, with the advantages of short time of hospitalization, few complications and high satisfactory rate.

关 键 词：麻醉 静脉 门诊外科手术 经会阴 前列腺穿刺活组织检查 

分 类 号：R614[医药卫生—麻醉学] R699.8[医药卫生—外科学]