経尿道的前立腺切除術(TUR-P)後における予防的化学療法の検討

Abstract

A群は術当日に術後PIPC 2gを1回, 術後第1日目はPIPG 2gを1日2回静注とした。B群はA群と同様にPIPC静注の後継続して術後第2日目から5日目までTFLX 1回 300mgを1日2回経口投与とした。1)予防的化学療法の有効率は, 主治医判定では両群間に統計学的有意差を認めなかったが, 統一判定ではB群が有意に高い有効率を示した。2)4日以上のカテーテル留置群ではB群が有意に高い有効率を示し, 両群とも洗浄が行われていない方が有効率が高く, 特にA群では洗浄の有無による影響が大きかった。3)副作用はA群に1例B群に2例, 臨床検査値異常はB群で3例認められたが, 特に問題となるものはなかった

The usefulness of preventive chemotherapy was studied in transurethrally prostatectomized patients with no prior urinary tract infections. They were divided into two groups (A and B) randomized by the envelope method. A was administered intravenously piperacillin (PIPC) 2 g once after surgery, and twice on the following day. B was similarly administered PIPC intravenously, followed by oral administration of tosufloxacin tosilate (TFLX) 300 mg twice daily from the second to the fifth day. Of the total of 135 cases, 104, 45 in A and 59 in B, conformed to the patient standards established for analysis. Efficacy was assessed by the primary physician and also according to a unified standard in which the onset of a post-surgical infection and a bacteriuria of 10(4) or greater CFU/ml observed ten days after surgery were regarded as ineffective. An intergroup statistically significant difference was not observed in the efficacy rate assessed by the primary physician. However, according to the unified standard assessment, B showed a significantly higher efficacy rate (88.1%) than A (62.2%). The administration of TFLX following PIPC was useful. With an indwelling catheter, B exhibited a significantly greater efficacy rate when the retention period was four days or longer. The efficacy was greater in both groups if lavage was not performed, and this effect was greater in A. Consequently, the administration of TFLX was considered more useful for long-term indwelling catheter cases. Neither serious side effects, nor clinical test abnormalities were observed in this study.