局部浸润麻醉与黏膜表面麻醉在经直肠超声引导前列腺穿刺活检中的应用比较  

Comparison of periprostatic local anesthesia and topical anesthesia of rectal mucous membrane for transrectal ultrasound-guided prostate biopsy

作　　者：林思杰 吴杰英[1] 陆敏华[1] 李星豪 方友强[1] Lin Sijie;Wu Jieying;Lu Minhua;Li Xinghao;Fang Youqiang(Department of Urology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2020年第1期4-7,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：广东省自然科学基金项目资助(2018A030313946);广州市科技计划项目(201704020052);广东省自然科学基金(2018A030313261);广东省医学科研基金(A2018079)。

摘　　要：目的比较前列腺局部浸润麻醉与直肠黏膜表面麻醉在经直肠超声引导前列腺穿刺活检中应用的安全性和有效性。方法将2018年3月至8月中山大学附属第三医院拟行前列腺穿刺活检的疑似前列腺癌患者纳入本研究,前瞻性随机分成两组。实验组采用超声引导下利多卡因于前列腺基底部和精囊腺间交角周围的血管神经束进行局部浸润麻醉;对照组采用利多卡因凝胶直肠黏膜表面麻醉。收集患者穿刺前后基线特征及穿刺后VAS评分、穿刺前后膀胱残余尿、穿刺阳性率、Gleason评分及血尿等相关并发症进行比较。结果共66例患者纳入本研究。穿刺过程中实验组疼痛评分低于对照组。两组间穿刺阳性率、Gleason评分、残余尿、尿潴留、肉眼血尿、发热等没有组间差异。结论局部浸润麻醉比直肠黏膜表面麻醉更能明显缓解经直肠超声引导前列腺穿刺的疼痛,对穿刺阳性率无明显影响,是更安全有效的麻醉方法,但需要一定经验的超声医师引导。Objective To compare the efficacy and safety between periprostatic local anesthesia and topical anesthesia of rectal mucous membrane for trans-rectal ultrasound-guided prostate biopsy.Methods Patients with suspected prostate cancer undergoing prostate biopsy were randomly divided into two groups prospectively.Local infiltration anesthesia with lidocaine was performed in the experimental group under the guidance of color Doppler ultrasound in the angle between the prostate base and the seminal vesicles around the neurovascular bundle on each side with lidocaine;while the control group was treated with topical anesthesia of rectal mucous membrane.We collected baseline characteristics,VAS,residual urine volume measured twice:before biopsy,the first micturition right after biopsy.Associated complications including positive rate of biopsy and Gleason score were also recorded.Results A total of 66 patients were included in this study.The pain score of experimental group was lower than the control group.Experimental group had lower rate of urinary retention and catheterization.Both groups had similar positive rate of biopsy,residual urine volume,Gleason score and rate of fever.Conclusions Comparing with topical anesthesia of rectal mucous membrane,periprostatic local anesthesia relieved more pain associated with trans-rectal ultrasound-guided prostate biopsy.It was more effective and safer but it should be guided by experienced ultra-sound physician.

关 键 词：局部浸润麻醉 直肠 黏膜表面麻醉 超声引导 前列腺穿刺活检 前瞻性 随机对照研究 

分 类 号：R737.25[医药卫生—肿瘤]