日间手术模式下行经会阴前列腺穿刺活检术的围手术期管理

Perioperative management of transperineal prostate biopsy in daytime operation mode

目的探讨在日间手术模式下开展经会阴前列腺穿刺活检术的围手术期管理。方法 2017年7月至2018年11月B超引导下经会阴前列腺穿刺活检患者852例,所有患者均通过日间流程完成术前准备及评估,术前给予肠道抗生素抗炎、开塞露清洁肠道和心理支持,术中严格无菌操作、静脉麻醉联合利多卡因局部麻醉、标本收集和伤口加压包扎,术后加强病情观察及随访并做好常见并发症的防治。结果 852例患者全部穿刺成功,患者满意率99.3%(846/852),穿刺阳性率46.9%(400/852),术后出现轻微肉眼血尿205例(24.1%),严重血尿9例(1.1%),尿潴留18例(2.1%),会阴部疼痛38例(4.5%),及时给予对症处理后恢复,无感染、迷走神经反射等并发症发生。结论规范有效的围手术期管理对保证前列腺穿刺活检术顺利进行和减少术后并发症意义重大。

Objective To discuss the perioperative management of transperineal prostate biopsy in daytime operation mode. Methods From July 2017 to November 2018, 852 patients underwent transperineal prostate biopsy under the guidance of B-ultrasound. All patients completed the preoperative preparation and evaluation through the daytime process.Before the operation, they were given with intestinal antibiotic anti-inflammatory, Kaiselu to clean the intestinal tract and psychological support. During the operation, strict aseptic operation, intravenous anesthesia combined with lidocaine local anesthesia, specimen collection and wound pressure bandaging were carried out. After the operation, observation and follow-up were strengthened for prevention of common complications. Results 852 patients were successfully punctured, the patient satisfaction rate was 99.3%(846/852), the positive rate was 46.9%(400/852). After operation, 205 cases(24.1%) had mild gross hematuria, 9 cases(1.1%) severe hematuria, 18 cases(2.1%) urinary retention, 38 cases(4.5%) perineal pain. No infection, vagus reflex and other complications occurred after symptomatic treatment. Conclusions Standardized and effective perioperative management is of great significance to ensure the success of prostate biopsy and reduce postoperative complications.