CAJ | 학술논문

目的探讨B超引导下经直肠前列腺穿刺活检术(TRUSPB)并发感染性休克和多器官功能不全综合征(MODS)的诊断与治疗. 方法 1996年6月至2011年5月行TRUSPB并发感染性休克和MODS的患者2例,年龄分别为45、46岁,回顾2例患者的诊治经过,结合1991-2011年文献报道10例(中文文献3例,英文文献7例),分析TRUSPB发生严重感染的机制与防治策略.结果 2例穿刺过程顺利,术后16～40 h出现感染性休克和MODS,1例术后第4天死亡,1例治疗5d后好转.本组和文献报道的10例均起病急骤,病情进展迅速,2例死亡、1例双下肢坏疽行截肢术,病死率和病残率高.多有重复穿刺(4/12)、糖尿病(3/12)、慢性感染(3/12)和使用免疫抑制药(1/12)等危险因素.血培养阳性9例,病原菌以大肠埃希菌为主(8/9),且半数(4/8)为多重耐药菌；2例B-内酰胺酶( + )；1例喹诺酮耐药.9例经过碳青霉烯类抗感染治疗后痊愈. 结论 TRUSPB可引起感染性休克、MODS等严重并发症,应引起重视.对于有重复穿刺等危险因素患者,建议术前预防性使用碳青霉烯类抗生素,可改善预后.
목적 탐토B초인도하경직장전렬선천자활검술(TRUSPB)병발감염성휴극화다기관공능불전종합정(MODS)적진단여치료. 방법 1996년6월지2011년5월행TRUSPB병발감염성휴극화MODS적환자2례,년령분별위45、46세,회고2례환자적진치경과,결합1991-2011년문헌보도10례(중문문헌3례,영문문헌7례),분석TRUSPB발생엄중감염적궤제여방치책략.결과 2례천자과정순리,술후16～40 h출현감염성휴극화MODS,1례술후제4천사망,1례치료5d후호전.본조화문헌보도적10례균기병급취,병정진전신속,2례사망、1례쌍하지배저행절지술,병사솔화병잔솔고.다유중복천자(4/12)、당뇨병(3/12)、만성감염(3/12)화사용면역억제약(1/12)등위험인소.혈배양양성9례,병원균이대장애희균위주(8/9),차반수(4/8)위다중내약균；2례B-내선알매( + )；1례규낙동내약.9례경과탄청매희류항감염치료후전유. 결론 TRUSPB가인기감염성휴극、MODS등엄중병발증,응인기중시.대우유중복천자등위험인소환자,건의술전예방성사용탄청매희류항생소,가개선예후.
Objective To investigate the diagnosis and treatment of septic shock and multiple organ dysfunction syndrome (MODS) following transrectal ultrasound-guided prostate biopsy (TRUSPB). Methods We reported two cases,45 and 46 years old,of septic shock and MODS after TRUSPB from June 1996 to May 2011.10 cases like these two cases in literatures were acquired (3 cases in Chinese and 7 cases in English) from 1991 to 2011,and the causes of severe infections following transrectal prostate biopsy and its prophylactic procedures were discussed as well. Results The two cases,suffered postoperative septic shock and MODS 16 -40 h after being smoothly performed TRUSPB.One patient died four days after surgery and the other improved after five days antibiotic treatment.All the 12 cases had abrupt onsets and deteriorated rapidly,2 cases died and 1 case was performed amputation due to double lower limb gangrene,resulted in high mortality and morbidity.There are many risk factors,such as repeated puncture (4/12),diabetes (3/12),chronic infections (3/12) and used immune suppression (1/12),et al; blood culture was positive in 9 case and E.coli bacteria was the main bacteria(8/9),besides,half of them were multi-drug resistant (4/8) and other 2 cases were ESBLs ( + ) or 1 case was quinolone-resistant repectively.9 cases recovered after actively controlled infection using carbapenem and other treatment. Conclusions Transrectal ultrasound-guided prostate biopsy could cause serious complications such as septic shock,to which more attentions should be paid.Preoperative use of carbapenem should be recommended for patients with repeating biopsy or other risk factors.