TURP治疗以尿潴留为主要表现的老年前列腺脓肿的疗效  

Therapeutic effect of TURP for prostatic abscesses primarily presenting as urinary retention in the aged males

作　　者：刘奔 齐鹏飞 傅德望 司青乐 于晨熹 韩志富 Liu Ben;Qi Pengfei;Fu Dewang;Si Qingyue;Yu Chenxi;Han Zhifu(Department of Urology,The First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121001,China)

机构地区：[1]锦州医科大学附属第一医院泌尿外科,锦州121001

出　　处：《中华泌尿外科杂志》2024年第10期756-760,共5页Chinese Journal of Urology

摘　　要：目的探讨以尿潴留为主要表现的老年前列腺脓肿(PA)的临床特点及经尿道前列腺切除术(TURP)的疗效。方法回顾性分析2020年7月至2022年8月锦州医科大学附属第一医院收治的4例以尿潴留为主要表现的老年PA患者的病例资料。中位年龄68.0(62.0,77.0)岁。均因进行性排尿困难、不能自主排尿入院。4例均有寒战、高热,其中3例为入院前出现,1例为人院后出现。1例继发脓毒血症。会阴区疼痛2例。既往有糖尿病史2例,高血压病史2例。直肠指检:4例均有前列腺增大,其中前列腺触痛2例,波动感1例。4例均行血、尿细菌培养,血培养阳性3例,其中大肠埃希菌2例,肺炎克雷伯菌1例;尿培养阳性2例,大肠埃希菌和肺炎克雷伯菌各1例;血、尿细菌培养均阴性1例。4例的血C反应蛋白118~190mg/L,降钙素原1.39~13.45ng/ml。血清前列腺特异性抗原升高1例,为16.95ng/L;正常3例。术前国际前列腺症状评分(IPSS)31.5(28.7,34.3)分,生活质量(Q0L)评分5.0(4.2,5.8)分。经腹超声检查示4例前列腺均增大,前列腺回声不均,其中2例见前列腺内低回声区。3例行前列腺CT平扫检查,可见前列腺增大,其内见密度不均减低区。2例行前列腺MRI平扫检查,提示前列腺外周带脓肿。3例术前诊断PA,脓肿大小1.7~5.8 cm,其中多发脓肿1例;1例术前诊断为前列腺增生。经抗生素治疗后,在联合阻滞麻醉下行TURP,术中均在前列腺包膜处见脓腔,去除尿道侧脓腔壁,使脓腔充分开。术后留置F20三腔尿管。结果4例手术均顺利完成,手术时间30~90min。术后病理诊断均为良性前列腺增生,伴急/慢性炎细胞浸润。1例术后当日发热,体温最高38.6℃,药物治疗后好转。术后5d拔除尿管,4例均排尿通畅。1例术后出现短暂性尿失禁,复查尿常规发现尿路感染,嘱多饮水,应用口服抗生素治疗2周后好转。术后1个月复查,CT检查示所有患者的前列腺脓腔完全消失。术后IPSSObjective To investigate the clinical characteristics of prostatic abscesses(PA)primarily presenting as urinary retention in the elderly patients and the therapeutic effect of TURP.Methods A retrospective analysis was conducted on the case records of four elderly patients with PA who presented primarily with urinary retention and were admitted to our hospital between July 2020 and August 2022.The median age of the four patients was 68.0(62.0,77.0)years,all of whom were admitted to the hospital due to progressive difficulty of urination and inability to urinate.All four patients exhibited chills and high fever,with three cases presenting prior to admission and one case post-admission.One patient developed secondary sepsis,and 2 patients experienced perineal pain.Two patients had a history of diabetes,and 2 had a history of hypertension.The rectal digital examination of these four patients revealed prostate enlargement,with 2 cases of tenderness and one case of fluctuation sensation on the prostate.Blood and urine bacterial cultures were carried out in 4 patients,of which 3 patients were positive of blood culture with 2 cases of Escherichia coli and one case of Klebsiella pneumoniae,2 patients were positive of the urine culture with one case of Escherichia coli and one case of Klebsiella pneumoniae,and one patient was negative of blood and urine culture.Serum C-reactive protein(CRP)and procalcitonin(PCT)increased in these 4 patients,with 118-190 mg/L and 1.39-13.45 ng/ml respectively.One of the 4 patients had elevated serum PSA levels,with a value of 16.95 ng/L,while the remaining 3 patients had normal serum PSA levels.The median international prostate symptom score(IPSS)score before surgery was 31.5(28.7,34.3)points for these 4 patients,and the median quality of life(Q0L)score was 5.0(4.2,5.8)points.The transabdominal ultrasound examination of these 4 patients showed that the prostate was enlarged and the echo of the prostate was uneven,and the hypoechoic area in the prostate was found in 2 cases.On plain CT scan

关 键 词：前列腺脓肿 尿潴留 经尿道前列腺切除术 

分 类 号：R697.3[医药卫生—泌尿科学]