Chou Yi-Hong, Tiu Chui-Mei, Liu Jen-Yi, Chen Jen-Dar, Chiou Hong-Jen, Chiou See-Ying, Wang Jia-Hwia, Yu Chun
Department of Radiology, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan.
Ultrasound Med Biol. 2004 Jun;30(6):719-24. doi: 10.1016/j.ultrasmedbio.2004.03.014.
The purpose of this study was to analyze the transrectal ultrasound (US), or TRUS, and color Doppler ultrasonography (CDU) findings and therapeutic strategies with TRUS-guided procedures in 13 patients with prostatic abscess. Over a period of 6 years, 18 prostatic abscesses were diagnosed in 13 patients (mean age: 59 years). Diagnostic workup included TRUS, analysis of midstream urine, and analysis and culture of abscess fluid for leukocytes and pathogens. These patients were treated either conservatively (for abscess cavities < 1 cm in diameter), or by aspiration or draining procedures (cavities > or = 1 cm). The transrectal CDU findings were correlated to the treatment effects. The predisposing factors were also reviewed. In the 13 patients, the most common clinical symptom and sign were urinary frequency (77%) and pus cell in the midstream urine (92%). Predisposing factors were found in 11 men, with diabetes in 5 of them. In 10 patients, the definitive preinterventional diagnosis was based on the TRUS findings. TRUS with probe palpation demonstrated tiny floating echogenic speckles in the abscess cavity in 4 patients. CDU demonstrated increased color-flow signals at the margin and surrounding tissue of the abscess pockets. Abscesses with poorly defined boundaries had more prominent surrounding color-flow signals and achieved, with relative difficulty, a satisfactory aspiration procedure. Aspiration was done for all 11 abscesses between 1 and 3 cm. A total of 4 larger abscesses (> 3.0 cm) were treated with aspiration or drainage using a 5-French pigtail catheter. No surgical drainage was performed. Transrectal CDU may help in the evaluation of maturity of an abscess pocket. US-guided aspiration with an 18-gauge needle or drainage with a 5-French pigtail catheter significantly shortened the hospital stay.
本研究旨在分析13例前列腺脓肿患者经直肠超声（TRUS）及彩色多普勒超声（CDU）检查结果，以及TRUS引导下的治疗策略。在6年期间，13例患者共诊断出18个前列腺脓肿（平均年龄：59岁）。诊断性检查包括TRUS、中段尿分析以及脓肿液白细胞和病原体分析与培养。这些患者要么接受保守治疗（脓肿腔直径<1 cm），要么通过抽吸或引流手术治疗（脓肿腔直径≥1 cm）。将经直肠CDU检查结果与治疗效果进行关联分析。同时回顾了易感因素。13例患者中，最常见的临床症状和体征是尿频（77%）和中段尿中有脓细胞（92%）。11例男性患者发现有易感因素，其中5例患有糖尿病。10例患者的最终介入前诊断基于TRUS检查结果。4例患者经探头触诊的TRUS显示脓肿腔内有微小漂浮的强回声斑点。CDU显示脓肿腔边缘及周围组织的血流信号增强。边界不清的脓肿周围血流信号更明显，且相对难以顺利完成抽吸操作。对所有11个直径在1至3 cm之间的脓肿进行了抽吸。4个较大的脓肿（>3.0 cm）采用5法国猪尾导管进行抽吸或引流治疗。未进行手术引流。经直肠CDU有助于评估脓肿腔的成熟度。使用18号针进行超声引导下抽吸或用5法国猪尾导管进行引流可显著缩短住院时间。
