5种前列腺穿刺活检方式的对比研究  

Comparative study of five different systematic prostatic biopsies in the diagnosis and implication of prostate cancer

作　　者：张世革[1] 吴烨[1] 王久林[1] 乔迪[1] 丁毅[1] 

机构地区：[1]江苏省老年医院泌尿外科,江苏南京210024

出　　处：《中国肿瘤外科杂志》2014年第3期141-145,共5页Chinese Journal of Surgical Oncology

摘　　要：目的比较5种不同前列腺穿刺活检方式的前列腺癌检出率和并发症情况。方法收集2001年至2012年间前列腺穿刺活检的住院病例239例，分别采用经会阴6点、手指引导6点、经直肠超声引导6点、5区13针（13点）和6＋4（10点）5种不同穿刺活检方式分组。比较5种前列腺穿刺活检方式的阳性率及并发症情况；同时对比按年龄、直肠指检（DRE）结果、前列腺特异性抗原（PSA）和直肠超声（TRUS）情况分组后的相关结果。结果5种不同穿刺方式组的前列腺癌检出阳性率差异无统计学意义（x^2=6．530，P〉0．05）；5组血尿阳性率的差异有统计学意义（x^2=9．947，P〈0．05），其中5区13针组的血尿阳性率分别高于6＋4组和超声6点组（P〈0．005），手指6点组血尿阳性率高于6＋4组（P=0．005）。按不同年龄和PSA水平分组后，PSA〉20IXg／L组的前列腺癌检出阳性率高于〈10μg／L和10～20μg/L组（P〈0．0125）；〉80岁组的前列腺癌检出阳性率也高于〈70岁组（P〈0．025）；同时DRE阳性和TRUS可疑组的前列腺癌检出阳性率也均高于阴性组（均P〈0．05）。而各分层分组并发症发生情况均无统计学差异（均P〉0．05）。结论对国内临床就诊人群，初次穿刺活检者采用10点的前列腺扩充穿刺即可，部分临床局部进展或前列腺体积较小者，采用6点穿刺足够诊断需要。对未细分穿刺人群简单的统一采用12点以上的穿刺方式不应是最佳选择。Objective To compare five different systematic prostate biopsies for prostate cancer detection rate and implications. Methods Collecting 239 cases of prostate biopsies from 2001 to 2012, respectively grouped by using 5 different ways as follows： transperineal 6-core biopsy, sextant biopsies under finger guidance, sextant biopsies under transrectal ultrasound （TRUS） guidance, 13-core biopsy scheme, 10-core biopsy scheme. The positive rate and implications were compared in the 5 ways of prostate biopsies, and at the same time compared the related results after grouping by age, digital rectal examination （DRE）, prostate-specific antigen （PSA） and TRUS. Results It was not statistically significant of positive detection rate of prostate cancer in 5 different groups of prostate biopsies （x^2 = 6. 530, P 〉 0.05 ）, while the overall difference of the positive rate of hematuria in the 5 groups was statistically significant （X^2 = 9. 947, P 〈 0.05 ）. The positive rate of hematuria of 13-core biopsy scheme was higher than 10-core biopsy scheme and sextant biopsies under transrectal ultrasound （TRUS） guidance group （P 〈 0. 005 ）, and the positive rate of hematuria of sextant biopsies under finger guidance was also higher than 10-core biopsy scheme group （P = 0. 005 ）. Grouped according to the different age and the level of PSA, the positive rate of prostate cancer in the group of PSA 〉 20 μg/L was higher than that of PSA 〈 10 μg/L and 10 - 20 μg/L （P 〈 0. 012 5 ）, while the positive rate of prostate cancer in the group of more than 80 years old was also higher than that of less than 70 years old group （P 〈 0. 025 ）. At the same time, the positive rate of prostate cancer in both abnormal DRE findings and TRUS suspected group was also higher than that in the negative group （ P 〈 0.05 ）, but the incidence of implication had no statistical difference. Conclusions The majority of initial prostatic biopsy can only use 10-core extended prostatic biopsy, while simple s

关 键 词：前列腺癌 前列腺穿刺活检 穿刺方法 阳性检出率 

分 类 号：R737.25[医药卫生—肿瘤]