内镜治疗前列腺增生与尿道狭窄后并发感染的临床特征与治疗

Clinical characteristics and treatment of infection in urinary and male reproductive system after endoscopy surgery

目的探讨内镜治疗前列腺增生及尿道狭窄后并发泌尿男生殖系感染的临床特征、预防与治疗体会。方法回顾1997年6月～2006年8月在该院接受该类手术后出现泌尿男生殖系感染的病例,记录手术时间、出血量、并发症、尿管停留时间及感染的发生和持续时间、尿液细菌培养结果等资料。临床疑诊泌尿系感染者均行尿液细菌培养+药敏试验,选用敏感抗生素治疗。结果共82例,平均年龄46.7岁,其中前列腺电切、电汽化、等离子电切治疗57例,尿道内镜手术25例。手术均获成功,平均手术时间45.3min(30～126min),术后平均停留尿管时间6.8d(5～14d),术中出血68.2mL(15～250mL),平均随访22.5个月(10～102个月)。出现尿道炎53例,膀胱炎12例,睾丸附睾炎14例,肾盂肾炎3例。其中伴全身发热者54例(65.9%);尿细菌培养阳性48例(50.6%),以大肠埃希菌最常见,其次为凝固酶阴性葡萄球菌和不动杆菌属,真菌感染13例(15.9%)。经敏感抗生素治疗,78例(95.1%)获得治愈。结论无菌操作、充分引流、及时随访、合理选用抗生素是防治内镜治疗前列腺增生及尿道狭窄后并发泌尿男生殖系感染的有效措施。

[Objective] To evaluate the characteristics and treatments of urinary and male reproductive system infections after endoscopy operations in patients of benign prostatic hyperplasia （BPH） and urethrostensis. [Methods] The eases got infections in urinary and male reproductive system after endoscopy operations for BPH and urethrostensis were reviewed retrospectively. The operating time, blood loss, complications, time of urethral-tube stay, the time and sustain period of infection, the urine culture results were recorded. Urine culture was carried out when the ease was suspected of infection. Sensitive antibiotics were used according to the culture results. [Results] Eighty-two eases （average age 46.7y） were involved in this study. 57 eases have accepted transurethral resection of the prostate by electrode, vaporization loop and isotonic loop, 25 eases have been performed resection of urethral strictures. All the operations were successful. The average operating time was 45.3min （30-126min）, urethral tube stay time was 6.8d （5-14 d）, blood loss was 68.2 mL （15-250 mL）, and average follow-up time was 22.5 m. There were infections in 53 eases of urethras, 12 eases of bladder and 3 eases of renal pelvic. 54 eases （65.9%） had got fever, 48 eases （50.6%） had positive culture results. The pathogens were Escheriehia eoli, eoagulase negative staphylococci bacteria and aeinebaeter spp. Fungus was detected in 13 eases （15.9%）. 78 eases （95.1%） were recovery completely with effective antibiotics. [Conclusions] Sterile operating, adequate induction, timely follow-up, and using sensitivity antibiotics are effective treatments for the infections after endoscopy operations in BPH and urethrostensis patients.