经直肠超声（TRUS）引导下前列腺周围阻滞是否会增加 PSA 升高患者 TRUS 活检的脓毒症发生率？
Does periprostatic block increase the transrectal ultrasound (TRUS) biopsy sepsis rate in men with elevated PSA?
机构信息
Department of Urology, Singapore General Hospital, Singapore.
出版信息
Ann Acad Med Singap. 2013 Apr;42(4):168-72.
INTRODUCTION
Periprostatic nerve block (PPNB) is a common local anaesthetic technique in transrectal ultrasound-guided (TRUS) prostate biopsy, but concerns remain over the increased theoretical risks of urinary tract infection (UTI) and sepsis from the additional transrectal needle punctures. This study reviewed our biopsy data to assess this risk.
MATERIALS AND METHODS
Retrospective data collected from 177 men who underwent TRUS biopsy between July 2007 and December 2009 in a single institution were analysed. PPNB was administered using 1% xylocaine at the prostatic base and apex and repeated on the contralateral side under ultrasound guidance. Complications, including UTI sepsis, bleeding per rectum and acute retention of urine (ARU) were noted. Every patient was tracked for the first 2 weeks for complications until his clinic review. Demographic profi le, biopsy parameters and histological fi ndings were reviewed. Univariate and multivariate analysis of possible risk factors for development of sepsis after TRUS biopsy were performed. Statistical analysis was performed using SPSS 17.0.
RESULTS
Ninety (51%) men received PPNB and 87 (49%) did not. The groups were matched in age (PPNB: mean 62.7 ± 5.8 years; without PPNB: mean 64.4 ± 5.7 years) and prebiopsy prostate specific antigen (PSA) levels (PPNB: mean 8.2 ± 3.9 ng/mL; without PPNB: mean 8.3 ± 3.7 ng/mL). The PPNB group had a larger prostate volume, with more cores taken (P <0.05). On univariate and multivariate analysis controlling for age, PSA, prostate volume, number of cores taken and histological prostatitis, PPNB was not a significant risk factor for sepsis. Sepsis rates were 5.6% in the PPNB group and 5.7% in the other group (P = 0.956). Overall prostate cancer detection rate was 33.3%.
CONCLUSION
The risk of sepsis was not increased in patients who received PPNB, even though this group had larger gland volumes and more biopsy cores taken.
引言
前列腺周围神经阻滞（PPNB）是经直肠超声引导（TRUS）前列腺活检中常用的局部麻醉技术，但由于额外的经直肠针穿刺，人们仍然对尿路感染（UTI）和败血症的理论风险增加表示担忧。本研究回顾了我们的活检数据，以评估这种风险。
材料与方法
分析了 2007 年 7 月至 2009 年 12 月在一家医院接受 TRUS 活检的 177 名男性的回顾性数据。在超声引导下，在前列腺底部和顶点处使用 1%的利多卡因进行 PPNB，并在对侧重复进行。记录并发症，包括 UTI 败血症、直肠出血和急性尿潴留（ARU）。每位患者在诊所复诊前的前 2 周内都要跟踪并发症。回顾人口统计学特征、活检参数和组织学发现。对 TRUS 活检后发生败血症的可能危险因素进行单因素和多因素分析。使用 SPSS 17.0 进行统计分析。
结果
90 名（51%）男性接受了 PPNB，87 名（49%）没有。两组在年龄（PPNB：平均 62.7±5.8 岁；无 PPNB：平均 64.4±5.7 岁）和前列腺特异性抗原（PSA）水平（PPNB：平均 8.2±3.9ng/ml；无 PPNB：平均 8.3±3.7ng/ml）方面相匹配。PPNB 组前列腺体积较大，取芯数较多（P<0.05）。在单因素和多因素分析中，控制年龄、PSA、前列腺体积、取芯数和组织学前列腺炎后，PPNB 不是败血症的显著危险因素。PPNB 组和其他组的败血症发生率分别为 5.6%和 5.7%（P=0.956）。前列腺癌总检出率为 33.3%。
结论
即使 PPNB 组前列腺体积较大，取芯数较多，但接受 PPNB 的患者发生败血症的风险并未增加。
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