直肠超声引导经会阴模版12＋X 针前列腺穿刺活检术临床研究

摘要

目的：：评价直肠超声引导下经会阴模版12＋X针前列腺穿刺活检术的临床价值和安全性.方法：2009年9月~2014年5月,对临床怀疑为前列腺癌的1300例患者行直肠超声引导下经会阴模板前列腺穿刺活检术.1300例患者平均年龄70.5岁,穿刺前均行血清PSA监测(不少于2次)、前列腺直肠指诊、经直肠前列腺超声及前列腺磁共振平扫加动态增强.所有患者取截石位,1％利多卡因注射液10~20 ml会阴皮下及前列腺尖部局部浸润麻醉973例,骶管阻滞麻醉75例,硬膜外麻醉252例.共937例采用12＋X针穿刺,363例采用常规12针穿刺.结果：所有患者均顺利完成操作,活检针数12~24针,平均14.5针；活检时间15~30 min,平均20.4 min.术后发生一过性血尿201例,会阴部血肿14例,尿潴留21例,发热5例.穿刺病理结果：前列腺癌540例(41.5％),其中腺癌527例,其他类型肿瘤13例；前列腺上皮内瘤(PIN)57例(4.4％)；前列腺增生及各类前列腺炎703例(54.1％).T-PSA＜4μg/L、4~＜10μg/L、10~20μg/L及＞20μg/L组的穿刺阳性率分别为：13.1％、17.1％、31.9％、73.8％.T-PSA 4~＜10μg/L组(灰区)293例患者分别以 F/T PSA 和 PSAD 分组, F/T≥0.16和＜0.16组的穿刺阳性率分别为12.0％、18.8％,PSAD≥0.15和＜0.15组的穿刺阳性率分别为9.8％、21.5％.直肠指诊异常、经直肠超声异常及前列腺 MRI 异常患者的穿刺阳性率分别为：24.0％、30.1％、59.2％.12＋X针组穿刺阳性率为47.2％,12针组为34.5％.结论：直肠超声引导下经会阴12＋X 针前列腺穿刺活检术阳性率高,并发症少,是诊断前列腺癌的理想方法.%Objective:To explore the clinical value and safety of TRUS-guided transperineal biopsy with the 12+X method in the diagnosis of prostate carcinoma.Methods:A total of 1300 men underwent TRUS-guided transperi-neal biopsy with the 12+X method for suspected prostate carcinoma from Sep.2009 to May 2014.The average age was 70.5 years old.All patients received PSA level,digital rectal examination(DRE),TRUS and MRI examinations. 937 cases received 12+X-core method biopsy and 363 cases received 12-core biopsy.Their clinical data were retro-spectively analyzed.Results:The average number of biopsy core was 14.5(range 12 to 24).The average operation time was 20.4 min(15 to 30 min).Prostate carcinoma was detected in 540 (41.5%),accounting for 13.1%, 17.1%,31.9% and 73.8% in those with PSA <4.0μg/L,4-<10μg/L,10-20μg/L and >20μg/L respectively, 24.0% in those with abnormal findings DRE,30.1% in those with abnormal echoes on TRUS and 59.2% in those with abnormal echoes on MRI.Complications after prostatic biopsy included gross hematuria in 201 cases,acute uri-nary retention in 21 and fever in 5,but no other serious complications were observed.The positive rate was 47.2%in 12+X-core group and 34.5% in 12-core group.Conclusions:TRUS-gu ided transpefineal biopsy with the 12+X method,with high accuracy and fewer complications,is an ideal approach to the diagnosis of prostate carcinoma.