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摘要: 目的 本研究拟比较经尿道前列腺脓肿去顶术、经会阴前列腺脓肿穿刺术和全程抗感染药物治疗3种方法在前列腺脓肿的治疗效果。方法 选取2010年1月—2020年12月在华南理工大学附属第六医院泌尿外科收治的21例前列腺脓肿患者作为研究对象，收集所有患者的临床数据及资料。临床随机分为三组：经尿道前列腺脓肿去顶术组(7例)、经会阴前列腺脓肿穿刺术组(6例)和全程抗感染药物治疗组(8例)。对三组患者的治疗效果及住院时间进行比较分析。结果 经尿道前列腺脓肿去顶术组、经会阴前列腺脓肿穿刺术组和全程抗感染药物治疗组的平均住院时间分别为(10.51±2.65) d、(22.21±5.13) d和(19.18±9.64) d，三组比较差异有统计学意义(P=0.002)；其中经会阴前列腺脓肿穿刺术组的患者中有1例出院后2周复发再次入院继续药物抗感染治疗后痊愈，经尿道前列腺去顶术组的患者中有1例术后残留脓肿引起复发再次行经尿道前列腺去顶术，全程抗感染药物治疗组的患者均无复发，三组患者经过治疗后均痊愈。结论 经会阴前列腺脓肿穿刺术作为对适合患者的一种重要微创治疗方式，可以最大程度减少脓液引流过程中的创伤和风险，经尿道前列腺去顶术住院时间最短，而抗感染药物治疗是自始至终必不可少的重要治疗措施。
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关键词:
- 前列腺脓肿 /
- 经尿道前列腺脓肿去顶术 /
- 经会阴前列腺脓肿穿刺术 /
- 经尿道直肠彩超 /
- 抗感染 /
- MRI
Abstract: Objective To compare the efficacy among transurethral unroofing of prostatic abscess, transperineal prostatic abscess puncture and whole-course anti-infection drugs in the treatment of prostatic abscess.Methods Twenty-one cases of prostatic abscess treated in the department of urology of Sixth Affiliated Hospital of South China University of Technology from January 2010 to December 2020 were selected retrospectively. All cases were randomly divided into 3 groups: transurethral unroofing of prostatic abscess (n=7), transperineal prostatic abscess puncture (n=6) and full-course anti-infection drug treatment (n=8). The therapeutic effect and hospitalization time of the three groups were compared and analyzed.Results The average hospitalization time of transurethral unroofing of prostatic abscess, transperineal prostatic abscess puncture and whole-course anti-infection drug treatment were (10.51±2.65) days, (22.21±5.13) days and (19.18±9.64) days respectively. The difference was statistically significant (P=0.002). Among them, 1 case in the transperineal prostatic abscess puncture group relapsed 2 weeks after discharge and was re-admitted to hospital to continue anti-infection treatment. One case in the transurethral unroofing group underwent transurethral unroofing of the prostate again due to recurrence of postoperative residual abscess. There was no recurrence in all the patients treated with anti-infection drugs. All the cases in all groups were cured after treatment.Conclusion As an important minimally invasive treatment for suitable cases, transperineal prostatic abscess puncture can minimize the trauma and risk in the process of pus drainage, and the hospitalization time of transurethral unroofing of prostate is the shortest. Anti-infection drug therapy is an essential treatment from beginning to end. -
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表 表 1 三组患者基本资料、临床特征和诊疗结果比较
例(%)，X±S 项目 总体(n=21) 经尿道前列腺脓肿去顶术组(n=7) 经会阴前列腺脓肿穿刺术组(n=6) 全程抗感染药物治疗组(n=8) 年龄/岁 63.27±10.34 (38~73) 67.50±5.50 (56~72) 60.23±10.45 (42~73) 55.41±11.57 (38~71) 合并症 ≤1种 16(76.2) 5(71.4) 5(83.3) 6(75.0) ≥2种 5(23.8) 2(28.6) 1(16.7) 2(25.0) 糖尿病 3(14.3) 0 1(16.7) 2(25.0) 尿道侵入性操作 3(14.3) 1(14.3) 1(16.7) 1(12.5) 感染性休克 2(9.5) 0 1(16.7) 1(12.5) 主要临床症状 发热 19(90.5) 7(100.0) 6(100.0) 6(75.0) 会阴部疼痛 13(61.9) 5(71.4) 3(50.0) 5(62.5) 排尿困难 17(81.0) 6(85.7) 5(83.3) 6(75.0) LUTS 15(71.4) 6(85.7) 4(66.7) 5(83.3) 急性尿潴留 12(57.1) 4(57.1) 3(50.0) 5(62.5) 肉眼血尿 2(9.5) 0 0 2(25.0) 直肠指检波动感 14(66.7) 4(57.1) 4(66.7) 6(75.0) 尿培养 大肠埃希菌 14(66.7) 5(71.4) 4(66.7) 5(62.5) 肺炎克雷伯杆菌 3(14.3) 1(14.3) 1(16.7) 1(12.5) 铜绿假单胞菌 1(4.8) 0 1(16.7) 0 阴性 3(14.3) 1(14.3) 0 2(25.0) 血培养阳性(同尿培养) 9(42.9) 4(57.1) 2(33.3) 3(37.5) 平均PSA/(ng·mL-1) 58.53±15.20 (3.66~144) 36.46±13.90 (7.15~68.52) 45.20±10.10 (13.20~80.30) 68.65±15.12 (3.66~144) 平均PCT/(ng·mL-1) 30.53±11.20 (0.17~200) 25.53±8.20 (13.50~56.20) 36.53±9.32 (20.12~80) 59.43±28.20 (0.17~200) 平均前列腺体积/mL 58.20±33.20 (35~85) 61.22±25.50 (36~85) 49.60±9.80 (35~69) 62.30±25.10 (39~87) 前列腺脓肿 平均脓肿大小/mL 3.96±0.80 (2.0~6.0) 3.99±0.65 (3.0~5.0) 4.23±0.83 (3.0~6.0) 3.78±0.52 (2.0~4.5) 单发脓肿 8(38.1) 1(14.3) 4(66.7) 3(37.5) 多发脓肿 13(61.9) 6(85.7) 2(33.3) 5(62.5) 平均住院时间/d 16.15±8.65 (8~36) 10.51±2.65 (8~14) 22.21±5.13 (17~36) 19.18±9.64 (9~32) 复发 1(4.8) 1(14.3) 1(16.7) 0 死亡 0 0 0 0 
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