经直肠超声在老年前列腺结节良恶性鉴别中的应用价值  

Application value of transrectal ultrasound in differential diagnosis of benign and malignant prostatic tubercle

作　　者：姜学忠[1] 张士革 史进军[1] 丁毅[2] 

机构地区：[1]江苏省老年医院超声科,江苏省南京市210024 [2]江苏省老年医院泌尿外科,江苏省南京市210024

出　　处：《实用老年医学》2008年第4期283-285,共3页Practical Geriatrics

摘　　要：目的探讨老年前列腺结节的经直肠超声(TRUS)表现特点及其对良恶性病变的鉴别意义。方法回顾性分析99例老年前列腺结节的穿刺标本,根据穿刺活组织检查及手术结果将其分为老年前列腺良性结节组71例和恶性结节组28例,并对2组结节的形态、内部回声、边缘情况进行对比观察,比较2组结节内的血流动力学检测参数和病人的血清前列腺特异性抗原(PSA)浓度,探讨2种病变的鉴别诊断特征。结果老年前列腺良性增生结节表现以结节回声偏强为主,境界清晰,有假包膜,血供稀疏呈条状或枯枝状分布。癌性结节表现为回声偏低、形态不规则、呈小分叶状外侵、局部血流信号丰富、血管丛集而不对称。比较2组血流参数如收缩期峰值血流速度(PS)、舒张末期血流速度(ED)、血流阻力指数(RI)和收缩末期与舒张末期最大血流速度之比(S/D)等,恶性结节相对于良性结节的RI值减低,恶性结节的血清PSA浓度相对于良性结节增高(P<0.01)。结论老年前列腺的良、恶性结节,其内部回声及其血流变化均具有各自的分布特征,TRUS结合PSA可有利于提高对老年前列腺结节良恶性的鉴别,有助于减少创伤性检查和不必要的手术切除,但是最终诊断有赖于TRUS引导下前列腺穿刺活检。Objective To explore the ultrasonic features of prostatic tubercle detected by transrectal ultrasound and the diagnostic value of transrectal ultrasound in diagnosing benign and malignant lesions in the elderly. Methods A retrospective analysis was done on 99 puncture samples of prostatic tubercle in the elderly, which included 71 benign and 28 malignant prostatic tubercles according to pathological reports. Morphous, internal echo and verge of tubercles were compared. Also, haemodynamics in tubercles and serum PSA of patients were compared. Results Hyperechoes, distinct boundary, pseudo-capsule, decreased blood supply were ultrasonic features of benign prostatic tubercle, while uhrasonography of malignant tubercle showed low level of echo,irregular shape, abundant regional flow signal and intensive and dissymmetry blood vessel. The blood flow parameters ,such as the peak systolic velocity（PS） ,the end-diastolic velocity（ED） ,the resistance index （RI） and S/D （PS/ED） ,were compared between the two groups. The results showed that RI value of malignant tubercle was significantly higher than that of benign tubercle and serum PSA concentration of malignant tubercle was significantly higher than that of benign tubercle（P 〈 0. 01 ）. Conclusions Internal echo and blood flow changes are different between benign and malignant prostatic tubercle in the elderly. The combination of TRUS and PSA help the differential diagnosis of benign and malignant prostatic tubercle. Meanwhile, the two methods could decrease traumatic examination and unnecessary operation. However,the final diagnosis depends on prostate puncturation and biopsy.

关 键 词：经直肠超声 前列腺结节 彩色多普勒超声血流显像 前列腺特异性抗原 活组织检查 老年人 

分 类 号：R445.1[医药卫生—影像医学与核医学]