前列腺脓肿2例报告及近10年国内文献复习

目的:结合2例前列腺脓肿病例及文献复习,评估我国前列腺脓肿的新特点。方法:报告2例前列腺脓肿病例,以前列腺脓肿作为关键词或篇名检索中国期刊全文数据库及万方数据数字化期刊全文数据库1997～2006年的资料,进行荟萃分析。结果:2病例既往均无糖尿病史但均有血糖升高,1例发病前曾行下尿路器械检查。2例均表现为显著排便困难,会阴疼痛伴有高热,外周血白细胞均不高,尿常规检查无感染表现。病例1通过MRI确诊,脓肿破溃至尿道经用抗生素痊愈;病例2通过经直肠B超及CT确诊,经直肠B超穿刺引流后治愈。荟萃分析结果表明,糖尿病、留置尿管或尿道器械操作是前列腺脓肿的主要致病因素,致病菌主要是金黄色葡萄球菌和大肠埃希菌,临床表现主要是膀胱刺激症状、排尿困难及会阴疼痛,多数患者经B超确诊,需行穿刺引流或开放手术引流。结论:现阶段前列腺脓肿表现不典型、可疑病例应及时行经直肠B超或CT检查确诊,B超引导下脓肿穿刺引流简便有效。

Prostatic Abscess: A Report of 2 Cases and Meta-analysis of Domestic Literature in Recent 10 Years

OBJECTIVE: To report 2 cases of prostatic abscess and review the current characterstics of prostatic abscess in China. METHODS: Two cases of prostatic abscess were reported, and a meta-analysis was made of the literature from the Chinese National Knowledge Infrastructure database and Wanfang Data in recent 10 years. RESULTS: Both the cases had a high glucose level, and one of them had received instrumental examination of the lower urinary tract prior to the problem, both with difficult defecation, severe perineal pain and high fever, with normal peripheral white blood cell count and negative urine routine. One case of abscess was confirmed by MRI, ruptured into urethra and cured by antibiotics. The other case was confirmed by transrectal ultrasound and CT and cured by transrectal ultrasound guided needle aspiration. Meta-analysis showed that the predisposed factors were diabetes mellitus, the indwelling catheter and instrumentation of the lower urinary tract. Major pathogens were staphylococci aureus and Escherichia coli. For most patients, the diagnosis was mainly established by ultrasonography and the treatment included needle aspiration or surgery. CONCLUSION: The clinical symptoms of prostatic abscess are not typically presented and the differential diagnosis may be difficult. Imaging investigation is helpful, and transrectal ultrasonography can be used for both diagnosis and treatment.