两种不同局麻方法在经直肠前列腺穿刺活检术中的镇痛疗效比较

目的比较经直肠超声引导前列腺神经阻滞术和直肠内灌注2％利多卡因凝胶在前列腺穿刺活检术中的镇痛疗效。方法160例接受经直肠超声引导13点前列腺系统穿刺活检术的患者随机分为A、B两组。A组患者84例，在经直肠超声引导下，于前列腺基底部，左、右两侧精囊与前列腺交接处分别注射1％利多卡因5ml；B组患者76例，于活检前5min直肠内灌注2％利多卡因凝胶10ml。采用视觉模拟评分（VAS）评估两组患者在穿刺活检术中的疼痛程度。结果两组患者在平均年龄（t=0．73）、PSA水平（t=0．34）和前列腺体积（t=0．55）的差异无统计学意义（P〉0.05），具有可比性。A组患者VAS评分0～3分者76例，4～5分者6例，6～10分者2例。B组患者则分别为48例、18例、10例。两组患者VAS评分均值分别为1，2分、2．6分，差异具有高度统计学意义（t=4．73，P〈0.01）。两组患者均未出现局麻药的不良反应。结论经直肠超声引导前列腺神经阻滞术的镇痛疗效明显优于直肠内灌注2％利多卡因凝胶，值得临床推广应用。     

经直肠超声引导下前列腺穿刺活检术的临床意义

目的探讨经直肠超声引导下前列腺穿刺活检术的临床意义。方法对60例PSA〉4ng／ml、直肠指检异常或超声发现异常回声的患者采用前列腺穿刺活检术，其中30例患者采用骶管内麻醉下经直肠超声引导前列腺穿刺活检术，年龄45～86岁，平均68±3．6岁，PSA〈4ng／ml为4例，4-10ng／ml为10例，〉10ng／ml为16例。对照组30例，年龄50-84岁，平均70±3．5岁，PSA〈4ng/ml为3例，4-10ng／ml为9例，〉10ng／ml为18例。对照组采用直肠指检压迫下穿刺或表面麻醉下行经直肠超声引导下穿刺活检。结果骶管内麻醉组阳性率为60％（18／30），患者术中无疼痛表现，对照组阳性率为33％（10/30），患者在术中伴有不同程度的疼痛。结论与常规穿刺相比，骶麻下经直肠超声引导下前列腺穿刺活检术准确性高，疼痛较轻，更能被患者接受，值得临床推广使用。     

Periprostatic local anesthesia before ultrasound guided prostate biopsy

PURPOSE: We assessed the morbidity and benefit of periprostatic local anesthesia administered before ultrasound guided prostate biopsy. MATERIALS AND METHODS: After placing the transrectal ultrasound probe and visualizing the prostate 50 consecutive patients received local anesthesia before prostate biopsies. RESULTS: There was no morbidity associated with the infiltration of local anesthesia into the periprostatic neurovascular plexus. Only 1 patient had discomfort during prostate biopsies, and 10 patients who previously underwent biopsies without anesthesia commented favorably on the dramatic difference. CONCLUSIONS: Many patients have pain during transrectal ultrasound guided biopsies of the prostate and few clinicians provide a periprostatic nerve block before this procedure. A periprostatic nerve block administered before the biopsies dramatically decreases discomfort. We urge all urologists to attempt this procedure, and we are confident that they will adopt it as part of their practice.     

利多卡因局部麻醉在经直肠前列腺穿刺活检术中的应用

目的　评价利多卡因局部麻醉在超声引导经直肠前列腺穿刺活检术中的有效性和安全性。　方法　 150例PSA升高和 (或 )DRE异常和 (或 )TRUS异常患者接受超声引导经直肠前列腺10针穿刺活检术 ,随机分成 3组 ,每组 50例 ,第 1组在尖部及两侧的前列腺精囊连接部注射 2 %利多卡因 ,每点 3ml,第 2组注射生理盐水 ,第 3组为对照组 ;穿刺结束后即刻对患者进行VAS疼痛评分。　结果　利多卡因组疼痛评分 0～ 7.5分 ,平均 2 .0分 ;生理盐水组 0～ 9.1分 ,平均 4.0分 ;对照组 0～ 7.4分 ,平均 3 .7分。经方差分析检验 ,利多卡因组与生理盐水组及对照组差异有显著性意义 (P <0 .0 5) ,后两组间差异无显著性意义 (P >0 .0 5) ,利多卡因组疼痛程度低于生理盐水组与对照组。 150例患者观察 6～ 10d ,无并发症发生。　结论　利多卡因局部麻醉操作简便 ,安全有效 ,能显著降低患者术中的疼痛感觉 ,推荐为超声引导经直肠前列腺穿刺活检术中常规应用方法     

利多卡因局部麻醉在经直肠超声引导前列腺穿刺活检术中的临床应用

目的　评价利多卡因局部麻醉在经直肠超声引导前列腺穿刺活检术中的安全性。　方法　经直肠超声引导前列腺 10针穿刺活检术患者 15 0例 ,均因排尿困难就诊。随机分成 3组 ,每组5 0例。第 1组经直肠在前列腺尖部及两侧前列腺精囊连接部注射 1%利多卡因各 3ml;第 2组注射生理盐水 ;第 3组为对照组 ,直接行穿刺活检。穿刺结束时采用视觉模拟评分尺 (VAS)对穿刺过程进行疼痛评分 ;穿刺结束时及术后第 7天评判患者有无并发症及其程度。　结果　利多卡因组、生理盐水组及对照组疼痛评分分别为 1.96、3.98和 3.70 ,利多卡因组疼痛明显减轻 (P <0 .0 5 ) ,生理盐水组与对照组差异无显著性意义 (P >0 .0 5 )。利多卡因组术后无感染发生 ,直肠出血量 (3.96± 0 .39)ml,肉眼血尿发生率 76 % (38/ 5 0 ) ,排尿困难加重发生率 12 % (6 / 5 0 ) ,尿潴留发生率 2 % (1/ 5 0 ) ,轻度血管迷走神经反射发生率 10 % (5 / 5 0 ) ,与生理盐水组和对照组比较 ,差异均无显著性意义 (P >0 .0 5 )。　结论　前列腺尖部及两侧前列腺精囊连接部注射利多卡因局部麻醉 ,能显著降低穿刺过程中的疼痛及不适程度 ,不增加术中及术后并发症 ,推荐在经直肠前列腺穿刺活检术中常规应用。     

Transrectal biopsy of the prostate guided by transrectal ultrasound

The use of transrectal ultrasound in combination with the Biopty System provides a high accurate, efficient, and safe method for the diagnosis and staging of prostate cancer. Because both diagnosis and staging may be attained easily using one comprehensive procedure, we recommend ultrasound guidance be used for all initial biopsies of the prostate. When transrectal ultrasound-guided biopsy of a palpable hypoechoic abnormality is negative for cancer, digitally guided biopsy must subsequently be performed. In some cases, palpable abnormality may not be seen on ultrasound. We advocate the use of our biopsy procedure as an integral extension of transrectal ultrasound of the prostate. In an outpatient setting, biopsy may be performed immediately after finding a suspect lesion on ultrasound. In this way, patients are spared time and anxiety, and society is spared medical costs.     

A single injection of lidocaine as local anesthesia for ultrasound guided needle biopsy of the prostate.

PURPOSE: We evaluated the effectiveness of a single injection of lidocaine on patient tolerance of multiple needle biopsies of the prostate. MATERIALS AND METHODS: In 100 consecutive group 1 patients local anesthesia was achieved by a single bolus injection of 10 ml. lidocaine and multiple prostatic needle biopsies was performed under ultrasound guidance. At the end of the procedure patients were asked to complete a questionnaire regarding the level of pain. Answers were compared with those of 100 group 2 patients who underwent prostatic biopsy before the introduction of local anesthesia. RESULTS: Of the group 1 patients 93% had only slight discomfort during the procedure and 7% required a further 1 cc bolus of lidocaine. In 55% of group 2 patients the level of pain during the procedure was significant but bearable, in 35% it was considered unbearable and in 10% sedation with midazolam was necessary. There was no significant difference in complications in the 2 groups. CONCLUSIONS: A single injection of local anesthesia for prostatic biopsy proved to be efficient, well tolerated by patients and effective for decreasing the pain associated with the procedure.     

Periprostatic local anesthesia before transrectal ultrasound-guided prostate biopsy

PURPOSE: We prospectively assessed the safety and efficacy of periprostatic local anesthesia before transrectal ultrasound (TRUS)-guided prostate biopsy. MATERIALS AND METHODS: A total of 178 consecutive men undergoing transrectal prostate biopsy at our institution were enrolled in this study. From January to June 2001, 84 men underwent prostate biopsy without anesthesia (control group). From July to December 2001, 94 men received local anesthesia before prostate biopsies (anesthesia group). A 5-ml dose of 1% lidocaine was injected into the periprostatic nerve plexus on each side via a 22 gauge needle at 3 minutes before the procedure. Pain during and after biopsy was assessed using a 10-point visual analog scale (VAS). Complications were evaluated with a self-administered questionnaire. RESULTS: The average pain score during biopsy was 3.18 in the anesthesia group versus 4.16 in the control group (p = 0.0067), while average pain score on the next day was 2.12 and 2.25, respectively (p = 0.7451). In the anesthesia group 13% of patients had a pain score > 5 versus 34% in the control group (p = 0.0043). The complication rate showed no significant difference between the two groups. CONCLUSION: Periprostatic lidocaine injection is a safe and effective method of anesthesia for transrectal prostate biopsy.     

Bacteremia and bacteriuria after transrectal ultrasound guided prostate biopsy

PURPOSE: We determined the incidence and predisposing factors of bacteremia and bacteriuria after prostate biopsy with specific emphasis on the value of a pre-biopsy enema. MATERIALS AND METHODS: We randomized 50 men undergoing ultrasound and biopsy to rule out prostate cancer to receive a preoperative (25) or no (25) enema. Preoperatively urine was obtained for culture, and questionnaires regarding urological history and voiding symptoms were completed. The initial prostate biopsy, biopsy needle, and postoperative urine and blood specimens were cultured. The following day a symptom questionnaire was completed. RESULTS: Bacterial growth in post-procedure cultures did not correlate with the number of biopsies, prostate specific antigen, obstructive voiding symptoms, prostate volume, cancer or post-biopsy hematuria. Bacteriuria was noted in 44% of the cases and bacteremia was present in 16% of the patients, of whom 87.5% did not receive an enema (p = 0.0003). Only 1 patient had chills and fever greater than 37.5C, requiring additional antibiotics. On the followup questionnaire 12% of patients described dysuria, including 84% with bacteriuria after biopsy. CONCLUSIONS: Bacteremia and bacteriuria after multiple biopsies are common but usually asymptomatic. Bacteria is apparently introduced into the urine and/or blood from the rectum via the biopsy needle, which may be minimized by a pre-biopsy enema. Dysuria or a history of urinary tract infection did not predict problems after biopsy.     

利多卡因加布比卡因局部麻醉在前列腺穿刺活检术中的应用

目的探讨经直肠前列腺穿刺活检引起的疼痛规律，评价利多卡因加布比卡因局部麻醉的镇痛效果及安全性。方法经直肠行前列腺10针穿刺活检患者150例，随机分3组，每组50例，A组在尖部、两侧的前列腺体部与直肠壁间注入利多卡因加布比卡因复合剂（质量浓度为1％利多卡因、0．2％布比卡因、1：20万单位肾上腺素）各3ml，B组在相同位置注射1％利多卡因，C组直接行穿刺活检。对患者术中及术后1周内的疼痛行视觉模拟评分尺评分。结果A、B、C组术中疼痛评分分别为2．2±1．5、2．0±1．5、3．5±1．9，P〈0.01；术后1h疼痛评分分别为2．2土1．3、3．1±1.1、2．8±1．4，P〈0．01；术后1d分别为1．7±1.1、1.8±1．1、1．7±1．3，P〉0.05；术后6d均为0．2土0．5，P〉0.05。A组2例患者出现术后寒战高热，C组1例术后当晚出现低热。术后A、B、C组分别有1、3、4例患者需口服止痛药。结论经直肠前列腺穿刺活检引起的疼痛主要在术中及术后1d之内。联合应用利多卡因加布比卡因局部麻醉能显著降低患者术中、术后的疼痛程度，并能消除单用利多卡因麻醉引起的术后疼痛反弹现象。     

微通道和标准通道在经皮肾取石术中效果及安全性评价

目的比较微通道和标准通道在经皮肾取石术（PCNL）中的效果及安全性。方法 2008年8月至2009年6月,我院采用C-型臂X光引导穿刺,微通道（14～18F）和标准通道（20～24F）两种不同PCNL通道行经皮肾取石术治疗肾内结石67例,其中微通道组31例,标准通道组36例;男性39例、女性28例,年龄31～67岁,平均46.3岁;左肾结石40例,右肾结石27例;根据腹部KUB测量结石大小：纵径2.0～6.8cm,横径1.5～5.4cm。对两组患者一期结石清除率、手术时间、手术并发症等指标进行比较。结果两组患者分别成功建立微通道和标准通道一期行单通道经皮肾碎石取石术。微通道（14～18F,本组为16～18F）组31例,标准通道（20～24F,本组为22～24F）组36例。结石清除率分别为67.7%（21/31）和88.9%（32/36）,P〈0.05;手术时间分别为93±17.5min和82±12.1min,P〈0.05;术后发热（体温≥38.5℃）分别为25.8%（8/31）和5.6%（2/36）,P〈0.05;术中出血〉800ml分别为3.2%（1/31）和2.8%（1/36）,P〉0.05;住院时间分别为7.3±0.4d和7.1±0.6d,P〉0.05。结论本组研究结果显示,采用标准通道,运用8/9.8FWolf输尿管硬镜或李逊肾镜与U-100双频双脉冲激光碎石机治疗直径≥2cm的肾内结石比采用微通道具有清石效率高、手术时间短、术后发热发生率少等优点,与微通道相比,不增加术中术后出血、穿孔等并发症发生率。     

经直肠超声引导前列腺穿刺活检方案的合理选择

经直肠超声(TRUS)引导前列腺穿刺活检是前列腺癌诊断和制定合理治疗方案的常规手段。制定扩大前列腺系统性穿刺方案时需综合考虑患者的年龄、前列腺体积及健康状况等因素。在系统性穿刺活检的基础上结合靶向性穿刺活检可提高前列腺癌的阳性率。     

经直肠超声定位前列腺穿刺术后感染并发症的临床分析

目的:研究经直肠超声定位前列腺穿刺术(TRUSPB)术后感染并发症的特点、危险因素及其预防措施。方法:回顾性分析我院2010年1月~2013年6月行TRUSPB术的571例患者术后并发感染35例的临床资料并文献复习。结果:前列腺体积(45ml)可作为TRUSPB术后感染的独立的预测因素,而年龄、前列腺特异抗原(PSA)与感染并发症无明显统计学关联。结论:穿刺术前应评估危险因素,对于前列腺体积较大患者要告知感染风险,并积极预防对症处理,TRUSPB仍是临床首选的安全性较好的诊断前列腺癌的方法之一。     

Effect of intraprostatic local anesthesia during transrectal ultrasound guided prostate biopsy: comparison of 3 methods in a randomized, double-blind, placebo controlled trial

PURPOSE: We evaluated the effect of intracapsular anesthesia and periprostatic nerve block during transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: In a prospective, randomized, double-blind, placebo controlled study 152 consecutive patients were randomized into 3 groups. Group 1 of 41 patients was administered intraprostatic local anesthesia into the right and left sides with a total of 2 ml 1% lidocaine and a periprostatic injection of 2 ml saline later. Group 2 of 49 patients was administered intraprostatic injection of 2 ml saline, followed by periprostatic local anesthesia with 2 ml 1% lidocaine. Group 3 of 62 patients received intraprostatic and periprostatic local anesthesia with 2 ml 1% lidocaine. Patients were asked to grade the pain level using a 10-point linear visual analog pain scale 1) when the transrectal ultrasound probe was inserted, 2) during anesthesia, 3) during biopsy and 4) 20 minutes after biopsy. One-way ANOVA and the Kruskal-Wallis test with the Tukey post hoc test were used to compare patient characteristics and pain scale responses among the 3 groups. RESULTS: No major complications, including sepsis and severe rectal bleeding, were noted in any patient. There were statistically significant differences in pain scores among groups 1 to 3 during anesthesia (mean +/- SD 5.6 +/- 2.5, 6.7 +/- 2.3 and 4.9 +/- 2.1, p = 0.003) and during biopsy (4.3 +/- 2.7, 4.5 +/- 2.6 and 2.7 +/- 2.1, respectively, p = 0.032). There were no differences in pain scores among the 3 groups during probe insertion (p = 0.39). CONCLUSIONS: A combination of intracapsular anesthesia and periprostatic nerve block is an effective and useful technique that is well tolerated by the patient. It decreases the level of pain and discomfort associated with the prostatic biopsy procedure.     

经直肠超声引导下前列腺穿刺活检540例临床分析

目的评价经直肠超声引导下前列腺穿刺活检诊断前列腺癌（PCa）的临床应用价值,提高PCa的诊治水平。方法回顾性分析血PSA升高和（或）直肠指检前列腺结节及超声检查有异常的540例患者经直肠超声引导下前列腺穿刺活检的临床资料和声像图表现。其中直肠指诊异常者248例;超声显示有异常回声结节者178例,145例为低回声,占81.4％,42例在声像图上未发现异常;380例PSA〉10μg／L。结果540例活检中PCa220例,阳性率为40．7％,前列腺肉瘤4例,前列腺增生症269例,前列腺增生症并上皮内瘤（PIN）35例,前列腺炎9例,前列腺结核2例,非典型增生1例。结论经直肠超声引导下前列腺穿刺活检是诊断PCa的一种安全有效的检查方法。