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
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摘要
目的:分析内镜治疗前列腺增生与尿道狭窄后并发感染的病原菌种类与特点,探讨有效的治疗方法。方法:选取2009年1月至2014年9月在我院接受治疗的经内镜治疗前列腺增生与尿道狭窄后并发感染患者98例。回顾性分析患者临床资料,记录患者感染时间、尿液病原菌培养情况以及药敏试验结果和治疗效果。结果:98例感染患者中尿道炎患者65例,膀胱炎15例,睾丸附睾炎14例,肾盂肾炎4例。98例患者病原菌培养50株,阳性率为51.02%。50株中,革兰氏阳性菌11株占22.00%,革兰氏阴性菌31例占62.00%,真菌8株占16.00%。其中大肠埃希菌为主要感染病原菌,共25株占50.00%,其次为凝固酶阴性葡萄球菌和不动杆菌,各占10%。98例患者经治疗,治愈96例,治愈率为97.96%。结论:细菌感染是内镜治疗前列腺增生与尿道狭窄后并发感染的主要原因,其中大肠埃希菌是最常见病原菌,临床上做好防治措施降低感染率,对感染患者早期发现、及时治疗、合理用药是提高治疗效果的关键。
Objectives: To explore effective treatment methods through analysis of pathogens and features of complicated infection after the endoscopic treatment of benign prostatic hyperplasia and urethral stricture. Methods: 98 cases of complicated infection after endoscopic treatment of benign prostatic hyperplasia and urethral stricture from January 2009 to September 2014 in our hospital were selected. Retrospective analysis of clinical data was conducted. Time of infection,urine culture as well as pathogen susceptibility test results and treatment effect were recorded. Results: Among the 98 cases of infection,there were 65 cases of urethritis,15 cases of cystitisand epididymitis,14 cases of testicular and4 cases of pyelonephritis. There were 50 pathogens cultured with a positive rate of 51. 02%,including 11 Gram- positive bacteria strains accounting for 22. 00%,31Gram- negative bacteria strains accounting for 62. 00% and 8 Fungal strains accounting for 16. 00%. The main pathogenic bacterium was Escherichia coli with 25 strains accounting for 50. 00%,followed by coagulase- negative staphylococci,and acinetobacter,each of 10%. Of the 98 patients treated,96 cases were cured,a cure rate of 97. 96%. Conclusion: Bacterial infection is the main reason for complicated infection after the endoscopic treatment of benign prostatic hyperplasia and urethral stricture. The most common pathogen was E. coli. Good clinical prevention measures can reduce the prevalence of infection in patients. Early detection and timely treatment,reasonable medication is critical to improving therapeutic effect.
Objectives: To explore effective treatment methods through analysis of pathogens and features of complicated infection after the endoscopic treatment of benign prostatic hyperplasia and urethral stricture. Methods: 98 cases of complicated infection after endoscopic treatment of benign prostatic hyperplasia and urethral stricture from January 2009 to September 2014 in our hospital were selected. Retrospective analysis of clinical data was conducted. Time of infection,urine culture as well as pathogen susceptibility test results and treatment effect were recorded. Results: Among the 98 cases of infection,there were 65 cases of urethritis,15 cases of cystitisand epididymitis,14 cases of testicular and4 cases of pyelonephritis. There were 50 pathogens cultured with a positive rate of 51. 02%,including 11 Gram- positive bacteria strains accounting for 22. 00%,31Gram- negative bacteria strains accounting for 62. 00% and 8 Fungal strains accounting for 16. 00%. The main pathogenic bacterium was Escherichia coli with 25 strains accounting for 50. 00%,followed by coagulase- negative staphylococci,and acinetobacter,each of 10%. Of the 98 patients treated,96 cases were cured,a cure rate of 97. 96%. Conclusion: Bacterial infection is the main reason for complicated infection after the endoscopic treatment of benign prostatic hyperplasia and urethral stricture. The most common pathogen was E. coli. Good clinical prevention measures can reduce the prevalence of infection in patients. Early detection and timely treatment,reasonable medication is critical to improving therapeutic effect.
引文
[1]王亮,梁平,杨航,等.经尿道前列腺等离子双极电切术与经尿道前列腺电切术治疗大体积良性前列腺增生症.中国内镜杂志,2011,17(10):1064-1067.
[2]黄永斌,沈凤燕,侯思南,等.两环两沟法经尿道等离子体切除术治疗高龄重度前列腺增生.中国内镜杂志,2013,19(2):152-154.
[3]张雄峰,卢小刚,刘晓冰,等.两种腔内镜术式治疗良性前列腺增生的疗效及安全性探讨.中国内镜杂志,2012,18(10):1112-1114.
[4]何晟,魏立平.老年肺结核并发其他病原菌感染的病原菌分布及耐药性分析.中国老年学杂志,2014,34(11):2994-2995.
[5]Chauhan S,Schatloff O,Coelho RF,et al.47 Robot assisted radical prostatectomy in patients with a history of endoscopic treatment for benign hyperplasia of prostate:a propensity score based matched-pair analysis.European Urology Supplements,2011,10(8):548-549.
[6]汤元杰,张荣华,吕金东,等.经尿道腔内钬激光治疗上尿路移行细胞癌17例.武警医学,2010,21(9):789-791.
[7]熊林,胡卫列,邹茜,等.气压弹道碎石联合超脉冲等离子体双极腔内剜除法治疗前列腺增生症并膀胱结石(附48例报道).中国内镜杂志,2011,17(7):714-716.
[8]周杰,毛登久,李杨,等.等离子电切联合输尿管镜治疗尿道狭窄的临床分析.中国内镜杂志,2012,18(6):633-635.
[9]刘磊,马潞林,侯小飞,等.经皮顺行通道联合经尿道逆行通道双向内镜微创手术治疗移植肾输尿管梗阻.北京大学学报(医学版),2013,45(4):588-591.
[10]Vicari E,Calogero AE,Condorelli RA,et al.Male accessory gland infection frequency in infertile patients with chronic microbial prostatitis and irritable bowel syndrome:Transrectal ultrasound examination helps to understand the links.Journal of Andrology,2012,33(3):404-411.
[11]廖晓星,侯垒,崔功静,等.经尿道选择性电切治疗高危前列腺增生与传统电切比较.中华临床医师杂志(电子版),2012,6(5):1295-1297.
[12]李家仁,李强,张弦,等.36例前列腺增生手术后医院感染调查.中华医院感染学杂志,2013,23(10):2353-2354,2359.
[13]张雄伟,陈强文,周练兴,等.前列腺增生合并膀胱结石同期手术治疗的临床分析.中国全科医学,2011,14(20):2319-2321.
[14]魏建军,秦建瑞,赵瑜,等.经尿道前列腺汽化电切术联合经皮膀胱穿刺造瘘气压弹道碎石治疗前列腺增生合并膀胱结石.中国微创外科杂志,2012,12(8):718-720.
[15]忻玲.前列腺增生术后感染的危险因素及护理体会.中华医院感染学杂志,2013,23(6):1361-1362.
[16]侯征,陈旭东,赵磊.标准通道与二期微创经皮肾镜取石术治疗上尿路结石感染性休克的对比观察.中国当代医药,2015,(5):44-47.
[17]杨守东,张卫星,卢浩彬.微创经皮肾碎石取石术治疗上尿路结石的临床疗效观察.中国医药科学,2014,(24):212-214.
[2]黄永斌,沈凤燕,侯思南,等.两环两沟法经尿道等离子体切除术治疗高龄重度前列腺增生.中国内镜杂志,2013,19(2):152-154.
[3]张雄峰,卢小刚,刘晓冰,等.两种腔内镜术式治疗良性前列腺增生的疗效及安全性探讨.中国内镜杂志,2012,18(10):1112-1114.
[4]何晟,魏立平.老年肺结核并发其他病原菌感染的病原菌分布及耐药性分析.中国老年学杂志,2014,34(11):2994-2995.
[5]Chauhan S,Schatloff O,Coelho RF,et al.47 Robot assisted radical prostatectomy in patients with a history of endoscopic treatment for benign hyperplasia of prostate:a propensity score based matched-pair analysis.European Urology Supplements,2011,10(8):548-549.
[6]汤元杰,张荣华,吕金东,等.经尿道腔内钬激光治疗上尿路移行细胞癌17例.武警医学,2010,21(9):789-791.
[7]熊林,胡卫列,邹茜,等.气压弹道碎石联合超脉冲等离子体双极腔内剜除法治疗前列腺增生症并膀胱结石(附48例报道).中国内镜杂志,2011,17(7):714-716.
[8]周杰,毛登久,李杨,等.等离子电切联合输尿管镜治疗尿道狭窄的临床分析.中国内镜杂志,2012,18(6):633-635.
[9]刘磊,马潞林,侯小飞,等.经皮顺行通道联合经尿道逆行通道双向内镜微创手术治疗移植肾输尿管梗阻.北京大学学报(医学版),2013,45(4):588-591.
[10]Vicari E,Calogero AE,Condorelli RA,et al.Male accessory gland infection frequency in infertile patients with chronic microbial prostatitis and irritable bowel syndrome:Transrectal ultrasound examination helps to understand the links.Journal of Andrology,2012,33(3):404-411.
[11]廖晓星,侯垒,崔功静,等.经尿道选择性电切治疗高危前列腺增生与传统电切比较.中华临床医师杂志(电子版),2012,6(5):1295-1297.
[12]李家仁,李强,张弦,等.36例前列腺增生手术后医院感染调查.中华医院感染学杂志,2013,23(10):2353-2354,2359.
[13]张雄伟,陈强文,周练兴,等.前列腺增生合并膀胱结石同期手术治疗的临床分析.中国全科医学,2011,14(20):2319-2321.
[14]魏建军,秦建瑞,赵瑜,等.经尿道前列腺汽化电切术联合经皮膀胱穿刺造瘘气压弹道碎石治疗前列腺增生合并膀胱结石.中国微创外科杂志,2012,12(8):718-720.
[15]忻玲.前列腺增生术后感染的危险因素及护理体会.中华医院感染学杂志,2013,23(6):1361-1362.
[16]侯征,陈旭东,赵磊.标准通道与二期微创经皮肾镜取石术治疗上尿路结石感染性休克的对比观察.中国当代医药,2015,(5):44-47.
[17]杨守东,张卫星,卢浩彬.微创经皮肾碎石取石术治疗上尿路结石的临床疗效观察.中国医药科学,2014,(24):212-214.