前列腺脓肿病例报道并文献复习

Prostate Abscess:Case Report and Review of the Literature

目的探讨前列腺脓肿(PA)临床特征,为临床治疗提供参考。方法选取2005年1月—2017年10月昆明医科大学第一附属医院收治的4例PA患者,在PubMed以"prostate abscess OR prostatic abscess"为标题或关键词检索2007年11月—2017年11月相关文献并进行PA的临床特征分析。结果 4例患者中有糖尿病病史2例,导尿史1例,前列腺增生1例;1例直肠指检触及波动感;2例患者脓液细菌培养为大肠埃希菌;均经手术治疗后痊愈。文献共纳入379例PA患者,其中糖尿病(28.0%)、尿道侵入性操作(12.9%)、免疫抑制(7.1%)是PA的主要易感因素;发热(59.6%)、尿路刺激征(36.7%)、疼痛(33.5%)为主要临床表现;大肠埃希菌(26.4%)、肺炎克雷伯杆菌(13.5%)、金黄色葡萄球菌(7.1%)为常见致病菌;多数患者需手术治疗。结论 PA早期症状无特异性,诊断困难,对疑似病例应及时行经直肠B超、CT或磁共振成像(MRI)明确诊断,治疗主要以敏感抗生素、经直肠PA穿刺引流术和经尿道PA去顶引流术为主。

ObjectiveTo explore the clinical features of prostate abscesses （PA） and provide reference for clinical treatments.MethodsFour PA patients admitted to the First Affiliated Hospital of Kunming Medical University from January 2005 to October 2017 were selected to investigate the clinical features of PA.Using the PubMed database with the title or keyword “prostate abscess OR prostatic abscess” from November 2007 to November 2017.Then,we analyzed the clinical features of PA.ResultsAmong the 4 patients,2 had a history of diabetes,1 had a history of catheterization,1 had a history of benign prostatic hyperplasia,1 had a sense of volatility following a digital rectal examination,and 2 had bacterial cultures of pus positive for Escherichia.coli.All of the patients recovered after surgery.A total of 379 PA patients were included in the literature search.Among the patients,diabetes （28.0%）,urethral tract invasion（12.9%）,and immunosuppression（7.1%） were the predominant susceptibility factors for PA.Fever（59.6%）,urinary tract irritation（36.7%）,and pain（33.5%） were the main symptoms.E.coli （26.4%）,Klebsiella pneumonia（13.5%）,and Staphylococcus aureus（7.1%） were common pathogens.Most of the patients required surgical intervention.ConclusionThe early symptoms of PA are not specific and are difficult to diagnose.Suspected cases of PA should be promptly diagnosed using transrectal ultrasound,CT,or MRI.The treatment of PA is mainly based on sensitive antibiotics,transrectal puncture and drainage of the PA,and urethral drainage to the top of the PA.