经直肠前列腺穿刺活检术后直肠活动性出血的临床分析

Reactive Proctorrhagia after Transrectal Prostate Biopsy

目的探讨影响经直肠前列腺穿刺活检术后直肠活动性出血并发症的相关因素,为提高诊治水平提供依据。方法回顾性分析1 127例经直肠前列腺穿刺患者的年龄、前列腺体积、前列腺特异抗原(PSA)、穿刺活检前是否应用抗凝药、穿刺针数、病理结果。经直肠前列腺穿刺活检术后发生直肠活动性出血8例,分析活动性出血部位、程度、处理方法、治疗转归。结果 1 127例经直肠前列腺穿刺活检术后发生直肠活动性直肠出血8例,发生率为0.71%,其中997例前列腺增生患者发生直肠活动性出血5例,130例前列腺癌患者发生直肠活动性出血3例。8例直肠活动性出血患者中有2例前列腺平面以上直肠活动性出血点1个,出血量300～400 ml,直肠镜下缝扎一针止血成功;4例直肠前列腺部活动性出血点1个、2例前列腺外侧直肠活动性出血点1个,出血量100～200 ml,均在直肠镜下采用双极电凝(功率20 W)止血加肛管压迫止血成功。直肠活动性出血与直肠无活动性出血患者的年龄、前列腺体积、PSA水平比较,差异均无统计学意义(P>0.05)。直肠活动性出血的影响因素分析显示,经直肠前列腺穿刺活检前是否口服抗凝药、穿刺针数均与术后直肠活动性出血无关,而患者前列腺疾病的性质与术后直肠活动性出血有关(P<0.05)。结论经直肠前列腺穿刺患者的年龄、前列腺体积、PSA、穿刺活检前是否应用抗凝药、穿刺针数与穿刺活检术后直肠活动性出血均无关,前列腺癌较前列腺增生患者易发生直肠活动性出血。正确处理术后直肠活动性出血就不会产生严重后果。

Objective To determine whether reactive proctorrhagia after transrectal prostate biopsy is affected by petential correlation factors and to improve our quality of diagnosis and treatment. Methods A total of I 127 transrectal prostate bi- opsy cases were retrospectively evaluated with the clinical data including age, prostate volume, prostate specific antigen, lowdose anticoagulant, biopsy protocol and histopathologic examination results analyzed. Eight patients were recorded with reactive proctorrhagia complication. Loci, severity, management, and outcomes of bleeding were analysed in these cases. Results Eight of the 1 127 patients were found with reactive proctorrhagia after transrectal prostate biopsy, with an incidence rate of 0. 71%. Among them 5 were from the 997 prostate hyperplasia patients and 3 were from the 130 prostate carcinoma patients. The bleeding loci were found in the rectum abovethe prostate in 2 of the reactive proctorrhagia patients, with the bleeding quantity amounted to 300 - 400 ml, were treated with suture hemostasis under the proctoscope. The bleeding loci were found in the rectum on the prostate and outside the prostate in 4 and 2 cases respectively, with the bleeding quantity amounted to 100 - 200 ml, these cases were successfully managed via electric coagulation under the proctoscope along with rectal pressure. Age, prostate volume, PSA levels were not significantly different between the proctorrhagia group and the patients without （ P 〉 0. 05 ） . Proctorrhagia was found to be associated with the characteristic of the disease （P 〈 0. 05 ） . Conclusion Proctorrhagia is not associated with age, prostate volume, PSA levels, use of anticoagulant drugs and times of puncture and is more likely to be found in carcinoma cases compared to benign hyperplasia. Appropriate treatment could prevent the occurrence of the more serious consequences.