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目的探讨直肠超声引导下经会阴前列腺穿刺活检并发症的发生情况。方法选择2009年11月—2012年11月进行直肠超声引导下经会阴前列腺穿刺活检的患者120例,术前均排空大便,未行常规灌肠及预防感染治疗,仪器选择Aloka Prosound5500超声仪、7.5MHz经直肠双平面探头及巴德穿刺针18G的自动活检针,采用标准6针系统穿刺活检法,穿刺标本用甲醛溶液固定后送病理检查。术后1周内对穿刺术后肉眼血尿、下尿路刺激症状、发热、会阴血肿、直肠出血、前列腺脓肿及感染性休克情况进行统计分析。结果 120例患者中出现肉眼血尿41例,占34.2%;其中,较明显肉眼血尿留置导尿者11例,占9.2%。尿路刺激症状表现为尿频尿痛14例,占11.7%;排尿困难5例,占4.2%。发热体温超过38.5℃5例,占4.2%。会阴血肿2例,占1.7%。未出现直肠出血及前列腺脓肿、感染性休克者。结论超声引导下经会阴前列腺穿刺虽有较多并发症,但大多轻微,严格规范消毒及精确熟练操作可进一步减少并发症发生,不需术前预防使用抗生素。
Objective To investigate the incidence of perineal prostate biopsy under the guidance of rectal ultrasound. Methods 120 cases of transperineal prostate biopsy under the guidance of rectal ultrasound were selected from November 2009 to November 2012. All cases were given stool emptying and no conventional enema and prevention of infection. The instruments were Aloka Prosound 5500, 7.5 MHz transrectal biplane probe and 18G automatic biopsy needle of the Bard needle. The standard 6-needle biopsy was used. The puncture specimens were fixed with formaldehyde solution and sent for pathological examination. Within 1 week after operation, gross hematuria, lower urinary tract irritation, fever, perineal hematoma, rectal bleeding, prostatic abscess and septic shock were statistically analyzed. Results There were 41 cases of gross hematuria in 120 cases, accounting for 34.2%. Among them, 11 cases of gross hematuria and catheterization were noted, accounting for 9.2%. Urinary tract irritation manifested as pollakiuria in 14 cases, accounting for 11.7%; dysuria in 5 cases, accounting for 4.2%. Fever body temperature over 38.5 ℃ in 5 cases, accounting for 4.2%. Perineal hematoma in 2 cases, accounting for 1.7%. No rectal bleeding and prostate abscess, septic shock were. Conclusion Although there are many complications of transperineal prostate biopsy guided by ultrasound, most of them are mild and severe. Sterilization and accurate proficiency can further reduce complications without preoperative antibiotic prophylaxis.