改制单角穿刺架经直肠超声引导前列腺随机活检的应用研究  

An Application Study of Transrectal Ultrasound Guided Prostate Random Histology Biopsy with Modified Single-angle Puncture Holder

作　　者：钱孝纲[1,2] 孙利国[1,3] 陈永昌[1,3] 

机构地区：[1]扬州大学医学院附属常熟医院 [2]常熟市第二人民医院超声科,江苏常熟215500 [3]常熟市第二人民医院泌尿外科,江苏常熟215500

出　　处：《临床误诊误治》2010年第2期132-134,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨改制单角穿刺架在直肠内超声(endorectal ultrasound,TRUS)引导下对前列腺进行随机活检的应用价值。方法选择有TRUS导向穿刺活检适应证的72例,将改制后的经阴道导向的单角穿刺架,在TRUS引导下采用Stamey的10点法做前列腺穿刺活检,并对取样标本、TRUS表现、血浆前列腺特异性抗原(PSA)浓度与前列腺癌的关系进行分析比较。结果本组用改制单角穿刺架作TRUS导向前列腺穿刺取材的成功率为99.23%,取样标本平均长度为(1.25±0.32)cm,能满足病理科的诊断要求。本组活检诊断为前列腺癌34例(47.22%),其中TRUS示弥漫性病变20例(58.82%),无明确占位病变的8例(23.53%),局灶性病变6例(17.64%)。弥漫性病变者穿刺活检7个穿刺点以上均找到癌细胞,无占位病变和局灶性病变半数以上病例癌灶受累范围≤4个穿刺点,但仍分别有37.50%(3/8)、33.33%(2/6)的病例癌灶受累范围≥7个点,前者与无占位病变、局灶性病变比较差异有统计学意义(P<0.01)。PSA浓度与前列腺癌的受累范围呈线性相关(α=0.51,P<0.05),局灶性前列腺癌的平均PSA值与前列腺增生者比较差异无统计学意义(P>0.05)。结论釆用改制单角穿刺架作TRUS引导前列腺随机活检,方法简便、安全,对早期诊断前列腺癌具有十分重要的临床价值。Objective To study the transrectal ultrasound （TRUS） guided prostate random histology biopsy with modified single-angle puncture holder. Methods A single-angle puncture holder was modified for TRUS guide prostate biopsy. Stamey＇s 10 points method was adopted to acquire specimens. The relationships between prostatic cancer specimens, TRUS detection and plasma PSA concentration were analyzed and compared. Results The achievement ratio of TRUS guided prostate biopsy was 99. 23% using modified single-angle puncture holder. The average length of samples wasn （ 1.25 ± 0. 32） cm, fulfilling the pathology department diagnosis requirement. The positive ratio of prostatic cancer sampiing was 47. 22% in this group. TRUS showed 20 patients （58. 82% ） had diffuse cancerigation, 8 patients （23.53%） hand lesion without proot of mass and 6 patients （ 17. 64% ） had local masses. Biopsy results showed that 7 puncture points found cancer cells in patients with diffuse eancerigation bat ≤4 were found in half of patients without proot of mass and only local masses. The biopsy results showed that 62. 5% was focal cancerization and 37.50% was diffuse lesion in patients without proof of mass in TRUS and 33.33% was diffuse cancerization in patients with only focal masses detected in TRUS. There was linear correlation between plasma PSA concentration and prostatic cancer involvement （α = 0. 51, P 〈 0. 05） and there was no significant difference in plasma PSA concentration between focal prostatic cancer and prostatic hyperplasia （ P 〉 0. 05 ）. Conclusion TRUS guided prostate random histology biopsy with modified single-angle puncture holder is an easy and safe method and has significant clinical value in early diagnosis of prostatic cancer.

关 键 词：前列腺肿瘤 腔内超声检查 活组织检查 针吸 

分 类 号：R737.25[医药卫生—肿瘤]