术前三维超声造影联合术中实时二维超声造影引导法在前列腺穿刺中的应用价值  

Application value of contrast-enhanced 3-dimensional ultrasound combined with real-time contrast-enhanced 2-dimensional ultrasound in prostate biopsy

作　　者：高康[1] 史秋生[1] 李凡[1] 姜露莹[1] 王泳[2] 张捷[2] 金宇飚[3] 林军[3] 杜联芳[1] 

机构地区：[1]上海交通大学附属第一人民医院超声科,上海市201600 [2]上海交通大学附属第一人民医院泌尿外科,上海市201600 [3]上海交通大学附属第一人民医院病理科,上海市201600

出　　处：《临床超声医学杂志》2015年第10期699-701,共3页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨术前三维超声造影联合术中实时二维超声造影引导法（以下简称为联合引导法）在不同血清前列腺癌特异抗原（PSA）水平下前列穿腺穿刺中的应用价值。方法对133例血清PSA升高（≥4 ng/ml）患者行经直肠前列腺穿刺,按PSA浓度分为A组74例（PSA 4~10 ng/ml）和B组59例（PSA≥10 ng/ml）。先行经直肠前列腺三维超声造影检查,然后在实时二维超声造影下对每例患者三维超声造影发现的异常区域穿刺2针,最后行前列腺底、中、尖三切面8针穿刺。以病理结果为标准,比较联合引导法与8针系统穿刺法对疑似前列腺癌患者穿刺活检的价值。结果 133例患者中56例病理诊断为前列腺癌;共穿刺1330针,236针标本病理检测出前列腺癌灶。A、B组患者阳性检出率分别为31.08%（23/74）和55.93%（33/59）。联合引导法在A组中阳性患者及阳性针数检出率均高于8针系统穿刺法（P〈0.05）,B组中两种方法的阳性患者及阳性针数检出率差异无统计学意义。结论 PSA水平为4~10 ng/ml的患者采用联合引导法穿刺较8针系统穿刺法可以获得更高的阳性患者检出率及阳性针数检出率。Objective To evaluate the application value of contrast enhanced 3-dimensional ultrasound（3DCEUS） combined with contrast-enhanced 2-dimensional ultrasound（2D-CEUS） in ultrasound-guided prostate biopsy with prostate specific antigen（PSA） in different levels.Methods Totally 133 patients with PSA higher than 4 ng/ml were evaluated in this biopsy study.All patients were divided into two groups according to the PSA levels ：group A（PSA4~10 ng/ml,74 cases）,group B（PSA≥10 ng/ml,59 cases）.Intrarectal 3D-CEUS was performed first,then under real-time CEUS guidance,biopsy was performed at 2 sites in abnormal nodules detected by 3D-CEUS,biopsy was last performed at 8 sites in the base,the mid gland and the apex in each patient.Taking pathologic results as reference standards,the diagnostic values were assessed in different groups with the two methods.Results Totally 56 people were diagnosed with prostate cancer in 133 patients.Totally 236 specimens were malignant in 1330 cores.The positive detection rate was31.08%（23/74） and 55.93%（33/59） in group A and B respectively.In group A,the positive detection rate of patients and specimens with combination method was higher than that with 8-cores systematic method（P〈0.05）,and the rates had no significant difference in group B.Conclusion 3D-CEUS combined with real-time CEUS-guided biopsy can improve both the patients detection rate and the specimens detection rate in patients with serum PSA of 4~10 ng/ml.

关 键 词：超声检查 三维 造影剂 二维 实时 前列腺癌特异抗原 穿刺 

分 类 号：R697.3[医药卫生—泌尿科学] R445.1[医药卫生—外科学]