前列腺脓肿治疗效果分析及经验总结  

Treatment outcomes and clinical experience of prostatic abscess

作　　者：张雨时 张恩浩 李晓刚 Zhang Yushi;Zhang Enhao;Li Xiaogang(Department of Urology,Yanbian University Hospital,Jilin 133000,China)

机构地区：[1]延边大学附属医院泌尿外科,吉林133000

出　　处：《中华泌尿外科杂志》2025年第3期198-204,共7页Chinese Journal of Urology

摘　　要：目的探讨前列腺脓肿的治疗效果并总结临床经验。方法回顾性分析2019年12月至2024年4月于延边大学附属医院诊治的23例前列腺脓肿患者的临床资料。年龄(57.72±16.09)岁,体质量指数(22.63±2.80)kg/m 2。合并糖尿病15例(65.2%),心脑血管疾病12例,肝炎并肝硬化2例;有前列腺增生病史3例(13.0%),前列腺炎病史3例(13.0%),近期有导尿史7例。临床表现:下尿路症状19例,伴有不同程度的发热14例。所有患者入院后均行尿细菌培养,阳性8例(34.8%),其中肺炎克雷伯杆菌4例,大肠埃希菌2例,金黄色葡萄球菌及铜绿假单胞菌各1例。所有患者入院时均行泌尿系超声检查;10例行全腹部CT检查;20例行前列腺MRI检查;20例明确诊断为前列腺脓肿,其余3例疑诊前列腺脓肿并于术中确诊;23例脓肿最大直径为11~70 mm,多发脓肿(≥2个)12例(52.2%),脓肿累及盆腔和阴囊4例。所有患者均全程行抗菌药物治疗,其中4例患者基础状态良好、抗感染治疗效果显著、脓肿复杂程度低,采用保守治疗。4例患者基础状态良好、抗感染治疗效果较好,相对年轻,同时至少存在1个较大脓肿,脓肿直径33~70 mm,在明确脓肿局限于前列腺区域及脓液形成后,行经会阴超声引导下穿刺引流。15例感染控制不佳且考虑为复杂性脓肿(多间隔/多发脓肿/多处受累/脓肿直径≥30 mm/体积≥20 cm 3),脓肿直径11~40 mm,采用经尿道前列腺切开引流术。结果23例随访时间3~12个月,平均随访时间10.8个月。行切开引流组无脓肿存在或复发,穿刺引流组及保守治疗组分别有2、1例脓肿持续存在,均为糖尿病患者。根据是否伴有糖尿病进行分组分析,糖尿病患者入院时血白细胞计数[16.7(11.8,17.4)×10^(9)/L与11.9(7.1,14.5)×10^(9)/L,P=0.045]及降钙素原[1.7(0.8,3.2)ng/ml与0.3(0,2.0)ng/ml,P=0.042]高于非糖尿病组。结论若患者基础状态良好,接受抗感染治疗后病情稳定,可根据脓肿直径、位ObjectiveTo evaluate the treatment efficacy of prostatic abscess and summarize clinical experience.MethodsA retrospective analysis was conducted on clinical data from 23 patients diagnosed with prostatic abscess at Yanbian University Hospital between December 2019 and April 2024.The mean age was(57.72±16.09)years,and BMI was(22.63±2.80)kg/m 2.Comorbidities included diabetes mellitus in 15 cases(65.2%),cardiovascular/cerebrovascular diseases in 12 cases,and hepatitis with cirrhosis in 2 cases.Medical histories comprised benign prostatic hyperplasia in 3 cases(13.0%),prostatitis in 3 cases(13.0%),and recent catheterization in 7 cases.Clinical manifestations included lower urinary tract symptoms in 19 cases and varying degrees of fever in 14 cases.All patients underwent urinary bacterial culture upon admission,with positive results in 8 cases(34.8%):Klebsiella pneumoniae(4 cases),Escherichia coli(2 cases),Staphylococcus aureus(1 case),and Pseudomonas aeruginosa(1 case).All patients received urinary tract ultrasound,while 10 underwent full abdominal CT and 20 underwent prostate MRI.Prostatic abscess was confirmed in 20 cases,while 3 suspected cases were intraoperatively confirmed.In the 23 cases,the maximum abscess cavity diameter ranged from 11 to 70 mm;multiple abscesses(≥2)were observed in 12 cases(52.2%),with pelvic and scrotal involvement noted in 4 cases.All patients received systemic antibiotic therapy,with 4 cases managed conservatively due to favorable baseline status,significant response to antibiotics,and low abscess complexity;4 cases with favorable baseline status,good response to anti-infective therapy,and younger age,along with at least one large abscess cavity(33-70 mm in diameter),underwent ultrasound-guided transperineal drainage after confirmation of abscess localization strictly within the prostatic region and established purulent material;and 15 cases with poorly controlled infections and complex abscesses(multiloculated/multiple abscesses/extensive involvement/diameter≥30 mm/volume≥20 cm

关 键 词：前列腺脓肿 治疗方式 穿刺 手术 预后 糖尿病 

分 类 号：R699.3[医药卫生—泌尿科学]