经尿道前列腺电切术前无菌尿的患者行预防性抗菌的合理性评价

目的 研究无菌尿的老年患者，经尿道前列腺电切术（TURP）时接受预防性抗菌方案的疗效。方法 120例TURP术前无菌尿的良性前列腺增生老年患者随机分为两组，抗生家组（60例）根据临床经验行静脉抗菌方案预防感染（4d），对照组（60例）则输注5％葡萄糖盐溶液。比较两组TURP术后感染相关性指标。结果 抗生素组在术后第4天的菌尿检出率低于对照组（P〈0．05），但两组术后第28天的菌尿率及其他感染相关性并发症比较差异元统计学意义。患者TURP术后第4天菌尿与术后长期菌尿、菌血症或尿路感染、前列腺菌群检出率关系不密切。结论 抗生素可以预防无菌尿老年患者TURP术后早期出现菌尿，但不能改善感染性并发症的发生率。经验性用药对不同来源分离的病菌不十分敏感。     

前列腺增生症并发腹股沟疝同期治疗两种不同术式比较

目的比较良性前列腺增生症（BPH）并发腹股沟疝同期两种手术的优缺点。方法18例患者随机分为两组。第1组10例,先行TURP术,再行无张力腹股沟疝修补术。第2组8例,作耻骨上“V”型切口（tunerwar—wick切口）,行耻骨上经膀胱前列腺摘除术（SPP）加传统疝修补术（巴西尼法）。观察两组患者术后膀胱冲洗时间、留置导尿管时间、住院时间及术后疗效。结果术后均平卧3～5d,并持续膀胱冲洗,TURP2—3d,开放性手术4～6d。TURP术后第4～5天拔除尿管,开放性手术术后11～14d拔尿管。第1组手术后住院时间为（7．21±0．60）,第2组为（13．00±0．71）,第1组明显低于第2组（P〈0．01）。随访3个月～5年,第2组例疝复发1例、尿失禁1例、手术均无切口感染。结论在BPH并发腹股沟疝的同期手术中,无张力疝修补术加TURP应为首选。前列腺大、有较大膀胱结石、髂关节强直、经济条件差患者应行经耻骨上“V”型切口行SPP加疝修补术。     

靶控温度管理对老年经尿道前列腺等离子电切术后感染的影响

目的探讨靶控温度管理对老年经尿道前列腺等离子电切术后感染的影响,为临床预防感染提供依据。方法选取2013年8月-2014年8月60例老年前列腺增生症患者为研究对象,按随机数字表分为观察组和对照组,各30例,观察组术中采用37℃灌注液,对照组术中采用室温灌注液,对比分析两组患者IPSS评分、残余尿量、前列腺切除组织质量和尿管留置时间及术后感染发生率。结果两组患者术后IPSS评分、残余尿量、前列腺切除组织质量比较,差异无统计学意义;观察组尿管留置时间(3.8±0.5)d,明显少于对照组尿管留置时间(4.5±0.4)d,差异有统计学意义(t=5.988,P<0.01);观察组术后感染2例,感染率为6.7%,对照组术后感染5例,感染率为16.7%,观察组感染率明显低于对照组,差异有统计学意义(χ2=3.015,P<0.05)。结论靶控温度管理用于老年经尿道前列腺等离子电切术,既可保障临床治疗效果、又可明显缩短患者术后尿管留置时间,减少感染发生率,值得临床应用。     

经尿道前列腺等离子双极电切术治疗前列腺增生的效果观察

目的探讨经尿道前列腺等离子双极电切术治疗前列腺增生的临床疗效和安全性。方法回顾性分析我院收治的72例前列腺增生患者的临床资料,根据治疗方法分为TURP组和PKRP组各36例,分别采用经尿道前列腺等离子双极电切术(PKRP)和传统的经尿道前列腺电切术(TURP)进行治疗,比较两组患者的临床疗效、手术情况以及并发症发生情况。结果两组患者术前IPSS、QOL、Qmax均无显著性差异,术后6个月后IPSS、QOL评分均显著降低,且PKRP组显著低于TURP组,Qmax较术前均显著升高,且PKRP组显著高于TURP组,P<0.05;PKRP组的手术时间、术后冲洗时间均显著短于TURP组,术后血红蛋白PKRP组显著高于对照组,P<0.05,术后留置尿管时间两组无显著性差异,P>0.05;术后TURP组的并发症发生率为19.44%,显著高于对照组8.33%,P<0.05,主要并发症状有包膜穿孔、继发性出血、尿道狭窄等。结论经尿道等离子双极电切术(PKRP)治疗前列腺增生临床疗效显著,并发症发生率低。     

定向抗菌药物应用预防前列腺切除术后尿路感染的临床研究

目的探讨定向抗菌药物应用预防前列腺切除术患者尿路感染的临床效果,降低前列腺切除术后尿路感染的发生率,提高前列腺切除术的治疗水平。方法选取2012年4月-2013年4月行前列腺切除术的患者120例,采用数字随机表法将其随机分为对照组和观察组,每组60例;对照组患者围术期按照抗菌药物临床应用规范实施常规抗感染措施,观察组患者术前5d实施肛拭子检测,并根据检测结果选择相应的抗菌药物进行定向抗菌预防术后尿路感染,比较两组患者术后感染症状、尿细菌定量培养及术后尿路感染率。结果术后尿路感染率对照组20.0%、观察组1.67%,对照组尿路感染率明显高于对照组,组间比较差异均有统计学意义(P<0.05);两组患者手术后12h内发热率观察组为1.67%、对照组为16.67%,48h后两组患者中段尿细菌定量培养检测,观察组低于对照组,差异均有统计学意义(P<0.05)。结论对实施前列腺切除手术的患者采取定向抗菌药物应用预防术后尿路感染,可显著降低患者术后尿路感染率。     

经尿道前列腺电切术后发生尿路感染的危险因素分析

目的 探讨经尿道前列腺电切(TURP)术后发生尿路感染的相关危险因素,以提高TURP手术疗效.方法 回顾性分析2000年1月-2012年6月收治行经尿道前列腺电切术患者285例的临床资料,对影响术后发生尿路感染的相关因素进行分析.结果 285例良性前列腺增生(BPH)患者TURP术后发生尿路感染43例,发生率15.1％；高龄、初学术者、合并糖尿病、术前有因尿潴留行导尿术、术前无预防应用抗菌药物、术后留置尿管时间长的患者感染率分别为23.8％、31.1％、45.3％、40.3％、40.2％、37.8％,是发生术后尿路感染的主要单因素；多因素logistic回归分析,术前糖尿病(OR=2.494)、术前因尿潴留行导尿术(OR=3.297)、术前预防应用抗菌药物(OR=1.815)、术后留置尿管的时间(OR=2.925)是TURP术后发生尿路感染的危险因素.结论 合并糖尿病、术前有因尿潴留行导尿术、术后留置尿管时间长使术后尿路感染发生的风险增加；术前有预防应用抗菌药物是保护因素,能降低TURP术后尿路感染发生的风险.     

老年糖尿病人行TURP围手术期护理对策

目的探讨老年糖尿病患者行经尿道前列腺电切术(TURP术)围手术期影响病人预后的护理因素,并提出相应对策.方法选择本科行TURP老年糖尿病患者50例作为实验组,对照组为同期手术的50例非糖尿病患者,从两组一般情况、预后情况两方面共10个项目加以比较.结果两组在情绪、对健康知识需求,术后并发症发生率等方面均有统计学意义(P＜0.01),老年糖尿病组感染率较对照组增加18%,拔管后排尿不畅增加14%,发生尿道狭窄增加4%,术后出血时间延长增加22%.结论老年糖尿病较非糖尿病行TURP的患者面临更多心理不适及并发症问题,必须采取相应护理对策,促进通畅排尿.     

经尿道前列腺汽化切割术联合电切术治疗前列腺增生的近远期疗效比较研究

目的　对比性地研究经尿道前列腺汽化切割术 (TUVP)与经尿道前列腺汽化切割术联合电切术 (TUVP +TURP)治疗良性前列腺增生的疗效及术后近远期并发症。方法　收集TUVP组和TUVP +TURP组的临床病例 ,观察手术前后的国际前列腺症状评分 (IPSS)、生活质量评分 (QOL)、最大尿流率 (Qmax)以及术后近远期并发症。结果　术后 12个月 ,两组术后各参数比较 ,P >0 .0 5 ,差异无显著性意义 ,即两组的治疗效果相似。近期并发症比较 :联合治疗组稍优于TUVP组。结论　两种方法治疗前列腺增生均有效 ,TUVP +TURP在近期并发症方面稍优于TUVP组 ,但差异无统计学意义。     

经尿道等离子双极电切术与前列腺电切术的疗效比较

目的比较经尿道前列腺等离子双极电切术(PKRP)与经尿道前列腺电切术(TURP)治疗良性前列腺增生(BPH)的临床疗效。方法回顾2005年7月至2008年8月我院BPH患者根据手术方式不同分成PKRP组(144例)和TURP组(152例),比较两组术后最大尿流率(Qm ax)、剩余尿量(PVR)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)等指标。结果PKRP组与TURP组各组手术前后IPSS、QOL、PVR、QM ax差异有统计学意义(P<0.01),手术后两组IPSS、QO l、PVR、QM ax差异无统计学意义(P>0.05)。两组平均手术时间差异无统计学意义(P<0.05)。PKRP组术中出血量、围手术期及术后并发症较TURP组减少,差异有统计学意义(P<0.05)。结论PKRP与TURP治疗BPH疗效相近,平均手术时间相近,但PKRP术中出血量、围手术期及术后并发症较TURP明显减少,手术安全性高。     

老年糖尿病患者经尿道前列腺切除术围手术期血糖控制体会

目的探讨老年糖尿病患者经尿道前列腺切除术(TURP)围手术期血糖控制方法及其对手术的影响。方法对36例经尿道前列腺切除术合并糖尿病患者围手术期血糖控制情况进行回顾性分析。结果 36例患者入院时空腹血糖(12.6±1.8)mmol/L,术前应用胰岛素控制空腹血糖至6.0～7.8mmol/L后接受TURP,术中及术后继续使用胰岛素控制血糖至基本正常水平。36例患者中仅1例术后出现感染,据药敏选择有效的抗生素治疗后痊愈出院;余患者均未发生出血、感染等并发症。结论老年糖尿病患者经正确的围手术期处理将血糖控制至基本正常水平后可耐受TURP,手术可取得满意效果。     

Antibiotic prophylaxis in transurethral resection of the prostate with reference to the influence of preoperative catheterization

The value of prophylactic antibiotics in transurethral resection of the prostate (TURP) remains controversial. We have conducted a prospective study in which 308 patients undergoing TURP have been randomized to receive no antibiotic cover (n = 150) or 36 h perioperative cover with temocillin. In 62 patients the urine was found to be infected at the time of operation. In these patients the incidence of postoperative urinary-tract infection (UTI) was 33% in the group who received temocillin, and 87% in the control group (P less than 0.001). In patients with sterile urine at operation (n = 235), the incidence of postoperative UTI was 13% in the temocillin group compared with 24% in the control group (P less than 0.05). Gram-positive organisms were mainly responsible for infection which occurred in patients who had received temocillin. A high incidence of postoperative UTI occurred in patients who had required preoperative catheterization despite the fact that their preoperative urine specimen was sterile. We conclude, (i) prophylactic antibiotics are of benefit in patients undergoing TURP, (ii) the antibiotic administered should be active against both gram-positive and gram-negative organisms, (iii) patients with an indwelling catheter should be considered at a higher risk of infection whether or not organisms are cultured from their preoperative urine specimen.     

Is antibiotic prophylaxis necessary in patients undergoing ureterolithotripsy?

Transurethral Ureterolithotripsy (TUL) is a frequently used procedure in urology departments. Many urologists perform TUL without antibiotic prophylaxis; however the use of chemoprophylaxis before TUL remains a controversial issue in urology. This study was carried out to assess the safety of omitting antibiotic prophylaxis prior to TUL. In a prospective randomized clinical trial from January 2005 to December 2007, 114 patients with ureteral stones were enrolled; Fifty seven had preoperative antibiotic prophylaxis administered before TUL and fifty seven patients underwent TUL without antibiotic prophylaxis. The rate of postoperative infectious complications (fever, positive blood culture, significant bactriuria), the length of hospital stay and overall stone free rate were compared between the two groups. There was no statistically significant difference between two groups in the operation time, length of hospital stay, postoperative bacteriuria, positive urine culture, postoperative fever and overall success rate of TUL. It appears that the incidence of infectious complications does not increase in patients undergoing TUL without antibiotic prophylaxis if they have negative pre-operative urine culture and antiseptic technique have been performed thorough the procedure.     

Comparative analysis of two regimens of antibiotic prophylaxis in elective colorectal surgery

BACKGROUND: Antibiotic prophylaxis has greatly reduced the rate of postoperative infectious complications since its utilization in the elective colorectal surgery in the last several decades. Although the need of its application is indisputable, the optimal duration of antibiotic prophylaxis is still on debate. AIM: The aim of the present study was to compare two regimens of antibiotic prophylaxis with different duration. MATERIALS AND METHODS: A retrospective clinical study was conducted of 190 patients that underwent elective surgery for colorectal carcinoma in the Clinic between January 1997 and June 2000. The patients were divided into two groups according to the regimen of antibiotic prophylaxis. Group 1 (n = 92) patients received a 24-hour antibiotic prophylaxis and Group 2 (n = 98) had a prolonged antibiotic cover that lasted 5 days. The antibiotic prophylaxis was conducted with a third generation cefalosporin and metronidazole. RESULTS: Of all 190 patients 92 were in Group 1 and 98 in Group 2. Postoperative infectious wound complications were found in 14 (15.2%) patients from Group 1 and in 25 (25.5%) patients from Group 2. The difference did not reach statistical significance (P > 0.05). CONCLUSION: The results of the study show no advantage of the prolonged over short-term antibiotic prophylaxis. Based on the study findings the authors suggest that a 24-hour antibiotic prophylaxis should be recommended for the lower rate of side effects and lower cost.     

The postoperative bacteriuria score: a new way to predict nosocomial infection after prostate surgery.

OBJECTIVE: Urinary tract infections are the leading nosocomial urologic infections and may be a cause of added morbidity and costs, and sometimes sepsis. The aim of this study was to design a predictive score for these complications after prostate surgery. DESIGN: Multicenter prospective survey. SETTING: Eleven French urology centers. PATIENTS: All patients undergoing transurethral resection of prostate (TURP) during a 3-month period. RESULTS: The overall incidence of postoperative bacteriuria was 25.0% (95% confidence interval, 17.7%-29.5%). Almost all patients (95.7%) received antibiotic prophylaxis. A predictive postoperative bacteriuria score (POBS), with a 6-point scale of 0 to 5, was constructed on the basis of independent risk factors identified in multivariate analysis of a test sample of patients (n=135) and tested in a validation sample (n=73). Significantly more infections occurred in patients with a POBS of 2 or higher (87 [8%] vs 48 [50%]; P<.0001). With the test sample, this yielded a sensitivity of 77%, a specificity of 77%, a positive predictive value of 50%, a negative predictive value of 92%, and a global accuracy of 77%. CONCLUSIONS: POBS could be used to distinguish patients at risk of developing infection after TURP. This information might be useful for implementing selective prevention measures or for adjustment for differences in nosocomial infection rates when comparing data between urology centers.     

Infected urine as a risk factor for postprostatectomy wound infection

OBJECTIVE: To study the relation of preoperative infected urine and postprostatectomy wound infection in patients with and without indwelling bladder catheters. DESIGN: Patients undergoing prostatectomy were evaluated for the presence of infected urine prior to prostatectomy and postoperative wound infection. They were further divided into patients with indwelling urinary catheter and catheter-free patients. All had received antibiotic prophylaxis. PATIENTS: One hundred fifty consecutive patients undergoing open prostatectomy--mean age was 67 years; 100 patients with an indwelling catheter for a mean period of 50 days; 50 catheter-free patients. RESULTS: Wound infection was found in 19 of 81 (23.5%) and in 6 of 69 (8.7%) patients with infected and sterile urine, respectively (p = .028). In patients with indwelling catheters prior to operation, wound infection was 22.4% when urine was infected and 8.3% when it was not. In patients without catheters, infected urine was associated with 40% of wound infections, as compared with 8.9% of wound infections in patients with sterile urine. Organisms obtained from infected wound and urine were identical in 84% of cases. These results were obtained despite antibiotic prophylaxis. CONCLUSIONS: Wound infection has been demonstrated to be a postprostatectomy complication directly related to the presence of urinary infection at surgery; thus, elective prostatectomy should be deferred until urine becomes sterile.     

膀胱结石对前列腺增生症患者术后下尿路症状恢复的影响

目的研究膀胱结石对前列腺增生患者术后下尿路症状恢复的影响。方法筛选71例单纯前列腺增生患者．55例前列腺增生并发膀胱结石患者,前者进行经尿道前列腺电切术（TURP）,后者同时进行结石清除术．对比分析临床资料。比较术后IPSS评分改善,依据结石的大小、形状将前列腺增生并发膀胱结石分为小、大结石组。统计分析各组术前膀胱出口梗阻程度（BOO）及残余尿量的差异。结果单纯前列腺增生组IPSS评分改善率为33．80％（24／71）,而前列腺增生并发膀胱结石组IPSS评分改善的比率为56．36％（31／55）,P＜0．05;两组间BOO和残余尿量均无显著差异（P＞0．05）;前列腺增生并发膀胱结石患者中大结石组BOO小于小结石组（P＜0．05）,而残余尿量无显著差异（P＞O．05）。结论在对膀胱结石进行治疗后前列腺增生患者术后症状得到明显改善。     

National study on the utilization of prophylactic antibiotics in surgery, Belgium, 1986

During the last week of May 1986, a 1-week prospective study on antibiotic utilization in surgical patients was held in 104 (42%) of the 247 Belgian acute care hospitals. All surgical patients with a post-operative stay of at least 3 days were studied, involving 3112 patients. Each patient was observed for 7 days, starting from the day before surgery. Antibiotics were administered to 71.9% of all patients; 21.9% received therapeutic antibiotics and 52.9% prophylactic antibiotics; 2.9% received both. Of the 1285 patients undergoing a surgical procedure with no indication for antimicrobial prophylaxis, 50.7% nevertheless received prophylaxis; 92.8% of patients with a generally recognized indication for prophylaxis received antibiotic prophylaxis. Less than one fifth (17.1%) of all prophylactic courses were stopped on the day of the intervention whilst 26.3% were continued up to the fifth post-operative day or beyond. The most frequently prescribed drugs for this indication included first and second generation cephalosporins and nitroimidazoles. The number of different generic drugs utilized per hospital ranged from 1 to 18 (mean: 7.7).     

强化性护理干预对TURP术并发症的影响

目的:探讨强化性护理干预对经尿道前列腺电切除术(TURP)并发症的影响。方法:将80例前列腺增生(BPH)行TURP术的患者,随机分为对照组和干预组两组。对照组采用常规护理措施,干预组采用强化性护理干预措施。结果:干预组TURP术并发症的发生率明显低于对照组,且病人平均住院时间较对照组明显缩短。结论:采用强化性护理干预能够有效减少和预防TURP术并发症,提高护理质量,提高手术成功率,缩短患者住院时间。     

Use of a preprinted sticker to improve the prescribing of prophylactic antibiotics for hip fracture surgery

Problem: Antibiotic prophylaxis has been shown to reduce the number of postoperative infections following surgery for hip fracture. At Auckland Hospital the policy for antibiotic prophylaxis for hip fracture surgery is for the patient to receive the first dose of antibiotic at the induction of anaesthesia followed by two more doses at 8 hour intervals. A previous audit found that patients often received too many doses of antibiotic. A retrospective audit was performed of 100 patients undergoing surgery for a hip fracture. The primary problem was over-prescribing; 68 patients (68%) received more than three doses. The number of patients who received three doses according to the guidelines was 29 (29%, 95% CI 21 to 40).     

经尿道等离子电切术治疗良性前列腺增生症

目的探讨经尿道等离子电切术治疗良性前列腺增生症的手术效果。方法入选的90例良性前列腺增生症患者随机分为治疗组和对照组各45例,治疗组采用经尿道等离子电切术治疗,对照组采用经尿道前列腺电切术（TURP）治疗,观察经尿道等离子电切术治疗良性前列腺增生症的手术效果。结果PKRP术后IPSS、QOL、MFR、RUV与术前比较均有显著变化。且PKRP术的平均手术时间、术中及术后出血量,术后住院时间均明显短于对照组（P〈0．05）。两组并发症发生卒差异有统计学意义（P〈0．05）。结论经尿道等离子电切术治疗良性前列腺增生症可以缩短手术时间,降低并发症的发生率,值得临床推广。