摘要
目的:回顾性分析本中心11例前列腺脓肿患者的临床、影像学特点,治疗选择及预后情况,结合相关文献为前列腺脓肿诊断和治疗提供新的思路。方法:回顾性分析11例住院治疗明确前列腺脓肿的患者,从电子病历中提取的临床信息包括:基本人口学信息统计、危险因素、临床症状、实验室检查结果、影像学表现(超声、CT、MRI)、治疗方式(经尿道前列腺脓肿去顶、保守治疗)、治疗相关并发症及最终结局。结果:2016年5月至2022年8月诊断为前列腺脓肿住院治疗患者共11例,年龄(64.18±7.19)岁,所有患者均有1种以上的合并症,糖尿病患者有5例(45.5%),8例(72.8%)患者最常见的症状是排尿困难。3例患者盆腔CT确诊,8例患者前列腺MRI确诊,6例(54.5%)为多发脓肿,10例脓肿直径>2 cm,脓肿直径平均为3.84 cm。只有3例患者入院后尿培养阳性,1例患者血培养阳性,病原菌为肺炎克雷伯杆菌2例,粪肠球菌1例,其中1例肺炎克雷伯杆菌为多重耐药菌。3例患者采用抗生素保守治疗,8例患者采用经尿道前列腺脓肿去顶术加抗生素治疗。患者静脉用抗生素使用时间(12.9±3.88) d,住院时间(19.18±8.20) d。随访3个月后复查保守治疗患者中仍有2例脓肿持续存在,手术患者无脓肿存在或复发。结论:前列腺脓肿相对不常见且没有特异性临床表现,影像学检查对准确诊断十分重要。治疗时要注意患者潜在全身合并症可能,需要进行多学科联合诊治,注意根据患者脓肿特点和患者整体情况选择合适治疗方式。
Objective: To analyze the clinical features, imaging characteristics, treatment options and prognosis of prostatic abscess(PA), and provide some new ideas for the diagnosis and treatment of the disease. Methods: This retrospective study included 11 cases of confirmed PA treated in the Fifth Medical Center of PLA General Hospital. We analyzed the clinical data obtained from the electronic medical records, including basic demographic statistics, risk factors, clinical symptoms, laboratory results, imaging findings, treatment methods, treatment-related complications and outcomes. Results: The 11 patients diagnosed with PA between May 2016 and August 2022 were aged(64.18 ± 7.19) years and all had at least 1 comorbidity, including 5 cases of diabetes mellitus(45.5%) and 8 cases of dysuria(72.8%). PA was confirmed in 3 cases by CT and in 8 cases by MRI, 6(54.5%) multifocal and 10(90.9%) >2 cm in diameter, with a median size of 3.84 cm. After admission, positive urine culture was found in 3 cases, positive blood culture in 1, Klebsiella pneumoniae in 2 and Enterococcus Faecalis in 1. Three of the patients were treated by intravenous administration of antibiotics alone, and the other 8 by transurethral PA unroofing in addition. Antibiotics medication lasted for a median of(12.9 ± 3.88) d and hospital stay averaged(19.18 ± 8.20) d. The patients were followed up for 3 months, which revealed the presence of PA in 2 of the cases treated with antibiotics alone, but not in any of the cases treated by surgery. Conclusion: PA is relatively rare and has no specific symptoms clinically. Imaging examination is very important for accurate diagnosis, and transurethral PA unroofing plus antibiotics administration could be considered as an optimal management of the disease.
作者
董金凯
付成伟
左世栋
孔令生
赵宝波
李学超
陈立军
DONG Jin-kai;FU Chen-wei;ZUO Shi-dong;KONG Ling-sheng;ZHAO Bao-bo;LI Xue-chao;CHEN Lijun(Department of Urology,The Third Medical Center of PLA General Hospital,Beijing 100853,China;Department of Urology,The Fifth Medical Center of PLA General Hospital,Beijing 100071,China)
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2022年第10期901-908,共8页
National Journal of Andrology
关键词
前列腺脓肿
急性细菌性前列腺炎
诊断
治疗
prostatic abscess
acute bacterial prostatitis
diagnosis
treatment
