超声引导下经直肠前列腺穿刺活检术在前列腺癌诊断中的意义  

Clinical significance of transrectal ultrasound guided prostate biopsy in diagnosis of prostate carcinoma

作　　者：刘海波[1] 孔垂泽[1] 姜元军[1] 李军[1] 赵伟[1] 荆宏伟[1] 于秀月[1] 

机构地区：[1]中国医科大学附属第一医院泌尿外科,沈阳110001

出　　处：《中国男科学杂志》2012年第6期41-45,共5页Chinese Journal of Andrology

摘　　要：目的评价超声引导下经直肠前列腺穿刺活检术（TUGPB）的安全性及在前列腺癌（PCa）诊断中的应用价值。方法回顾性分析本组2007年1月至2011年11月共495例接受血清前列腺特异抗原（PSA）的测定、并行经直肠超声引导下TUGPB的患者临床资料。2009年1月前共穿刺176例，活检点数为8点，由前列腺左右叶分别穿刺3点，中叶穿刺2点；2009年1月后共穿刺319例，活检点数为11～13点，分别穿刺前列腺左右叶各3点，左右侧外周带各2点，再于超声检查发现的前列腺内低回声区及中叶穿刺1～3点，油纱布置入直肠内压迫止血10—60min。穿刺前应用抗生素1d，穿刺后应用抗生素3d。结果总的癌检出率为37．8％（187／495），其中2009年1月前癌检出率为29．0％（51／176），2009年1月后癌检出率为42．6％（136／319），差异有统计学意义（P〈0．05）。本组495例患者，腺体中有低回声区者378例，其癌检出率为38．1％（144／378）；腺体中无低回声区者117例，其癌检出率为36．8％（43／117）；差异无统计学意义（P〉0．05）。穿刺后患者出现发热83例（16．8％），肉眼血尿57例（11．5％），排尿困难及尿痛43例（8．7％），血便31例（6．3％），血精19例（3．8％），均经对症治疗后痊愈。结论超声引导下TUGPB是诊断PCa的一种安全简便的方法，并发症较少且轻微可控；腺体中有无低回声区对PCa的检出率无明显影响差别；活检11～13点可以显著提高阳性率，而并不增加并发症的发生率。Objective To evaluate the safety and the clinical significance of transrectal ultrasound guided prostate biopsy（TUGPB） in the diagnosis of prostate cancer. Methods From January 2007 to November 2011, Clinical data of 495 patients who received systematic biopsied under the guidance oftransrectal ultrasound and serum PSA test were analyzed retrospectively. Before January 2009, 176 patients received 8 biopsy cores of the prostate including three points at each of the right and left lobe, and 2 points at the midlobar. After January 2009, 319 patients received 11-13 biopsy cores of the prostate. Three points at each of the right and left lobe and 2 points at the midlobar were punctured. Ifa hypoechoic area was identified, 1-3 points were taken from this area and the midlobar. Gauze was inserted into the rectum 10-60rain for compression hemostasis. Antibiotics were given 1 day before biopsy and 3 days after biopsy. Results Positive rate of the biopsy specimen was 37.8%（187/495） among 495 patients. There was a significant difference between positive rate of the biopsy specimen before January 2009（29.0%, 51/176） and after January 2009 （42.6%, 136/319） （P〈0.05）. The carcinoma detective rate was 38.1%（144/378） in patients with hypoechoic area and 36.8%（43/117） in non-hypoechoic area, there was no significant difference between them （P〉0.05）. After puncture, the complications were found including fever 83 cases （16.8%）, hematuria 57 cases （11.5%）, lower urinary tract symptoms （LUTS） 43 cases （8.7%）, rectal bleeding 31 cases （6.3%）, hemospermia 19 cases （3.8%）. All the patients with complications recovered after relative management. Conclusion Transrectal ultrasound guided systematic prostate biopsy is a safe method for diagnosis of prostate carcinoma. This procedure may be associated with minor complications. There is no obvious difference in the positive rate between the patients with hypoechoic areas and non-hypoechoic areas. Systematic 11-13 points biopsy may im

关 键 词：前列腺肿瘤/超声检查 活组织检查 针吸 

分 类 号：R737.25[医药卫生—肿瘤]