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腹腔镜单纯前列腺切除术后耻骨骨髓炎:耻骨切除伴部分膀胱切除术

Pubic Osteomyelitis After Laparoscopic Simple Prostatectomy: Pubic Bone Resection With Partial Cystectomy.

作者信息

Aragão Vital João, Marques Monteiro Miguel, Silva Soares José, Teves Frederico, Fraga Avelino

机构信息

Urology, Hospital Central do Funchal, Funchal, PRT.

Urology, Centro Hospitalar Universitário de Santo António, Porto, PRT.

出版信息

Cureus. 2024 Feb 1;16(2):e53390. doi: 10.7759/cureus.53390. eCollection 2024 Feb.

DOI:10.7759/cureus.53390
PMID:38435211
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10908421/
Abstract

Osteomyelitis of the pubic symphysis presents a diagnostic challenge, characterized by symptoms of pubic pain and discomfort radiating to the groin, thigh, or hip. Post-prostate surgery occurrences are rare, with a propensity for cancer-related procedures. Conservative antibiotic therapy may prove insufficient, necessitating surgical intervention. This article details a unique case involving infection, the second most prevalent pathogen. Despite the rarity of the diagnosis, particularly after a benign surgical procedure, timely intervention was hindered, leading to a delayed management course. The case involves a 69-year-old male with a history of benign prostatic hyperplasia who underwent laparoscopic simple prostatectomy. Post surgery, he developed recurrent urinary infection-related symptoms, leading to hospitalization. Diagnostic tools such as CT scans, MRI, and F-18-FDG-PET/CT scan played crucial roles in identifying the inflammatory process. Subsequent surgical debridement, pubic bone resection, and partial cystectomy, followed by an eight-week antibiotic course, led to a favorable recovery. Discussion emphasizes the rarity of pubic symphysis osteomyelitis, particularly after benign surgery, underscoring the importance of imaging and timely intervention. The presented case adds to the limited literature on post-prostatectomy osteomyelitis, emphasizing the need for heightened clinical awareness and consideration of rare complications even in routine surgical scenarios.

摘要

耻骨联合骨髓炎是一项诊断难题,其特征为耻骨疼痛及不适症状放射至腹股沟、大腿或髋部。前列腺手术后发生耻骨联合骨髓炎的情况罕见,且多见于与癌症相关的手术。保守的抗生素治疗可能并不充分,因此需要进行手术干预。本文详细介绍了一个涉及感染(第二常见病原体)的独特病例。尽管该诊断罕见,尤其是在良性手术后,但及时干预受到阻碍,导致治疗过程延迟。该病例涉及一名69岁男性,有良性前列腺增生病史,接受了腹腔镜单纯前列腺切除术。术后,他出现了与复发性尿路感染相关的症状,随后住院治疗。CT扫描、MRI和F-18-FDG-PET/CT扫描等诊断工具在识别炎症过程中发挥了关键作用。随后进行的手术清创、耻骨切除和部分膀胱切除术,以及为期八周的抗生素疗程,最终实现了良好的康复。讨论强调了耻骨联合骨髓炎的罕见性,尤其是在良性手术后,突出了影像学检查和及时干预的重要性。该病例补充了关于前列腺切除术后骨髓炎的有限文献,强调即使在常规手术情况下,也需要提高临床意识并考虑罕见并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4034/10908421/fbb0ae39b3fa/cureus-0016-00000053390-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4034/10908421/19e0b861549c/cureus-0016-00000053390-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4034/10908421/fbb0ae39b3fa/cureus-0016-00000053390-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4034/10908421/19e0b861549c/cureus-0016-00000053390-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4034/10908421/fbb0ae39b3fa/cureus-0016-00000053390-i02.jpg

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本文引用的文献

1
Symphysis Pubis Osteomyelitis: An Uncommon Complication after Robotic Assisted Radical Prostatectomy-Case Description with Literature Review.耻骨联合骨髓炎:机器人辅助根治性前列腺切除术后一种罕见的并发症——病例描述及文献综述
Case Rep Urol. 2018 Feb 13;2018:5648970. doi: 10.1155/2018/5648970. eCollection 2018.
2
Pubic Bone Osteomyelitis and Pubosymphyseal Urinary Fistula: A Poorly Recognized Complication in Prostate Cancer Survivors.耻骨骨髓炎和耻骨联合尿道瘘:前列腺癌幸存者中一种未被充分认识的并发症。
Oncology (Williston Park). 2017 Mar 15;31(3):169-73.
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The imaging of osteomyelitis.
骨髓炎的影像学检查
Quant Imaging Med Surg. 2016 Apr;6(2):184-98. doi: 10.21037/qims.2016.04.01.
4
Pubic symphysis osteomyelitis in the prostate cancer survivor: clinical presentation, evaluation, and management.前列腺癌幸存者的耻骨联合骨髓炎:临床表现、评估与管理
Urology. 2015 Mar;85(3):684-90. doi: 10.1016/j.urology.2014.11.020.
5
Pubic bone osteomyelitis after salvage high-intensity focused ultrasound for prostate cancer.挽救性高强度聚焦超声治疗前列腺癌后耻骨骨髓炎
Curr Urol. 2013 Feb;7(3):149-51. doi: 10.1159/000356268. Epub 2014 Feb 10.
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Bilateral thigh pain after treatment for prostate cancer.前列腺癌治疗后双侧大腿疼痛。
BMJ Case Rep. 2013 Mar 4;2013:bcr2013008784. doi: 10.1136/bcr-2013-008784.
7
A 57-year-old man with a history of prostatectomy and pelvic irradiation presents with recurrent urinary tract infections, hematuria, and pelvic pain.一名有前列腺切除术和盆腔放疗史的57岁男性,出现复发性尿路感染、血尿和盆腔疼痛。
Urology. 2013 Feb;81(2):221-5. doi: 10.1016/j.urology.2012.10.037.
8
Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy.骨感染影像学检查:平片、CT、超声、磁共振成像和核素扫描的作用。
Semin Plast Surg. 2009 May;23(2):80-9. doi: 10.1055/s-0029-1214160.
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[A case of osteomyelitis of the pubis after radical prostatectomy: a case report].[前列腺癌根治术后耻骨骨髓炎一例:病例报告]
Hinyokika Kiyo. 2009 Aug;55(8):523-6.
10
Septic arthritis of the pubic symphysis: review of 100 cases.耻骨联合化脓性关节炎:100例病例回顾
Medicine (Baltimore). 2003 Sep;82(5):340-5. doi: 10.1097/01.md.0000091180.93122.1c.