模板引导下经会阴的前列腺投影穿刺活检的并发症分析  

Complications of transperineal template-guided prostate mapping biopsy

作　　者：王飞 丁雪飞[1] 徐嘉男 徐耀宗 周宇权 栾阳[1] 卢圣铭[1] 陶华志[1] Wang Fei;Ding Xuefei;Xu Jia'nan;Xu Yaozong;Zhou Yuquan;Luan Yang;Lu Shengming;Tao Huazhi(Department of Urology, Northern Jiangsu People′s Hospital Affiliated to Yangzhou University, Yangzhou 225001, China)

机构地区：[1]扬州大学附属苏北人民医院泌尿外科,扬州225001

出　　处：《中华医学杂志》2019年第6期428-431,共4页National Medical Journal of China

摘　　要：目的 探讨模板引导下经会阴的前列腺投影穿刺活检(TTMB)并发症的发生情况。 方法 将首次经直肠活检阴性,前列腺特异性抗原(PSA)持续升高的患者纳入研究,随机分两组。观察组行TTMB,对照组行模板引导下经会阴的前列腺饱和穿刺活检(TTSB),术后评估两组出血、感染、尿潴留、勃起功能情况。使用国际勃起功能指数(IIEF-5)评估患者术前及术后1、3、6个月的勃起功能。 结果 TTMB组共33~116针,平均59针,TTSB组共11~44针,平均23针。TTMB组阳性率50%(30/60),TTSB组阳性率32.9%(27/82),两组比较差异有统计学意义(P<0.05)。TTMB组重度血尿和尿潴留发生率为8.3%(5/60)与11.7%(7/60),TTSB组分别为1.2%(1/82)和2.4%(2/82),两组比较差异有统计学意义(P<0.05),但轻中度血尿及总血尿发生率、血精、会阴区血肿、感染等并发症两组比较差异无统计学意义(P>0.05)。两组均未发生血便。TTMB组穿刺前与穿刺后第1、3、6个月的IIEF-5评分分别为(19.1±4.5)分;(17.4±4.8)分;(18.6±4.5)分;(19.0±4.0)分;TTSB组穿刺前与穿刺后第1、3、6个月的IIEF-5评分分别为(19.7±4.3)分;(18.2±4.5)分;(19.1±4.1)分;(19.6±4.2)分,两组穿刺后1个月与穿刺前比较差异有统计学意义(P<0.05),但两组间IIEF-5评分比较差异无统计学意义(P>0.05)。 结论 TTMB对于首次经直肠活检阴性、持续PSA升高的患者能提高阳性率,术后并发症发生率较低且大多是自限的,重度血尿和尿潴留发生率相对增加,临床干预后可恢复正常。术后勃起功能障碍(ED)是短暂性的,术后1个月勃起功能受到影响,但术后3~6个月后恢复到穿刺前水平。因此,TTMB是一种安全可靠的方法。Objective To assess the complications of transperineal template-guided prostate mapping biopsy (TTMB). Methods Between May 2017 and March 2018, 142 consecutive patients with prior negative transrectal biopsy results and persistently elevated prostate-specific antigen (PSA) were divided into the observation group and the control group randomly. The observation group underwent TTMB and the control group underwent transperineal template-guided prostate saturation biopsy (TTSB). Bleeding, infection, urinary function were recorded after prostate biopsy. Erectile function (ED) was measured at baseline, 1 month, 3 months and 6 months after prostate biopsy using the International Index of Erectile Function (IIEF-5). Results A mean of 59 cores (from 33 to 116 cores) were obtained in TTMB, and a mean of 23 cores (from 11 to 44 cores) were obtained in TTSB. The positive rate was 50.0% (30/60) in TTMB, and 32.9% (27/82) in TTSB, and there were significant differences between two groups (P<0.05). The incidence of severe hematuria and urinary retention was 8.3% (5/60) and 11.7% (7/60) respectively in TTMB, while 1.2% (1/60) and 11.7% (7/60) respectively in TTSB. There were significant differences between two groups (P<0.05). But there were no significant differences between two groups in the incidence of mild, moderate and total hematuria, hematospermia, perineal hematoma, infection (P>0.05). Rectal bleeding was not observed. In TTMB group, the IIEF-5 scores at baseline, 1 month, 3 months and 6 months were (19.1±4.5), (17.4±4.8), (18.6±4.5), (19.0±4.0), respectively. In TTSB group, the IIEF-5 scores at baseline, 1 month, 3 months and 6 months were (19.7±4.3), (18.2±4.5), (19.1±4.1), (19.6±4.2), respectively. There were significant differences between baseline and 1 month after prostate biopsy in two groups (P<0.05), but there were no significant differences of IIEF-5 score between the two groups (P>0.05). Conclusions TTMB can improve the positive rate for patients with prior negative transrectal biopsy results and pers

关 键 词：前列腺肿瘤 活检 并发症 

分 类 号：R697.3[医药卫生—泌尿科学]