MRI/TRUS认知融合联合12针系统经会阴前列腺穿刺活检的临床研究  

MRI/TRUS cognitive fusion combined with 12-core systematic transperineal prostate biopsy for the diagnosis of clinically significant prostate cancer:A report of 208 cases

作　　者：付振宇 孙利国 张鸽 顾怡峰 贝明龙 胡俊 陈永昌 张杰[1] FU Zhen-yu;SUN Li-guo;ZHANG Ge;GU Yi-feng;BEI Ming-long;HU Jun;CHEN Yong-chang;ZHANG Jie(Department of Urology,Changshu Second Peoples Hospital/the 5th School of Clinical Medicine of Yangzhou University,Changshu,Jiangsu 215500,China)

机构地区：[1]扬州大学第五临床医学院暨常熟市第二人民医院泌尿外科,江苏常熟215500

出　　处：《中华男科学杂志》2021年第5期421-425,共5页National Journal of Andrology

摘　　要：目的:探讨磁共振/经直肠超声(MRI/TRUS)认知融合联合12针系统经会阴前列腺穿刺活检诊断临床显著性前列腺癌(CS-PCa)的比例及并发症的发生情况。方法:回顾分析我院2015年6月至2019年5月MRI/TRUS认知融合联合12针系统经会阴前列腺穿刺活检208例患者的临床资料,患者年龄54~85(67.6±7.8)岁;均为首次穿刺,术前均行直肠指检(DRE)、PSA、TRUS、前列腺多参数磁共振成像(mpMRI)检查。发现DRE可疑结节47例;tPSA<4μg/L 2例,4μg/L≤tPSA<10μg/L 64例,10μg/L≤tPSA<20μg/L 93例,20μg/L≤tPSA<100μg/L 45例,tPSA≥100μg/L 4例;TRUS发现异常结节36例;mpMRI发现异常信号结节208例。术者仔细阅读mpMRI图像,寻找可疑信号区,并给与标记;待患者麻醉成功后,TRUS再次进一步观察前列腺,并结合mpMRI图像,进行认知融合,确定前列腺穿刺的靶点,先经会阴认知融合靶向穿刺2~3针后,再经会阴12针前列腺系统穿刺,穿刺标本送病理检查。结果:208例患者发现CS-PCa 112例;PSA分层研究发现tPSA<4μg/L 0例,4μg/L≤tPSA<10μg/L 21例,10μg/L≤tPSA<20μg/L 47例,20μg/L≤tPSA<100μg/L 40例,tPSA≥100μg/L 4例;BPH 85例;慢性前列腺炎8例;前列腺非典型性增生2例;前列腺上皮内瘤1例。术后出现全身炎症反应综合征3例,明显肉眼血尿和(或)血便12例,给予抗感染、止血等对症处理后患者均康复,无严重并发症发生。结论:MRI/TRUS认知融合联合12针系统经会阴前列腺穿刺活检能在一定程度上提高首次诊断CS-PCa的检出率,并发症发生率相对不高并且可控。Objective:To investigate the detection rate and complications of magnetic resonance imaging/transrectal ultrasonography(MRI/TRUS)cognitive fusion combined with 12-core systematic transperineal prostate biopsy(TPPB)in the diagnosis of clinically significant PCa(CS-PCa).Methods:This retrospective study included 208 patients undergoing first-time MRI/TRUS cognitive fusion combined with 12-core systematic TPPB from June 2015 to May 2019.The patients,aged 54-85(67.6±7.8)years,all received digital rectal examination,PSA detection,TRUS and prostate multiparametric MRI(mpMRI)before biopsy.We analyzed the mpMRI images,identified and marked the suspected signal areas,repeated TRUS for further observation of the prostate,conducted cognitive fusion based on the mpMRI images and determined the target before 12-core systematic TPPB and subjecting the samples obtained to pathological examination.Results:Of the 208 patients,112 were diagnosed with CS-PCa(no case with tPSA<4μg/L,21 cases with 4μg/L≤tPSA<10μg/L,47 cases with 10μg/L≤tPSA<20μg/L,40 cases with 20μg/L≤tPSA<100μg/L,and 4 cases with tPSA≥100μg/L),85 with BPH,8 with chronic prostatitis,2 with atypical prostatic hyperplasia,and 1 with prostatic intraepithelial neoplasia.Systemic inflammatory response syndrome occurred in 3 and gross hematuria and/or bloody stool in 12 cases after biopsy,which were all cured by anti-infection and hemostasis treatment.Conclusion:MRI/TRUS cognitive fusion combined with 12-core systematic transperineal prostate biopsy can improve the detection rate of the initial diagnosis of clinically significant PCa with a low incidence of controllable complications.

关 键 词：磁共振 经直肠彩超 认知融合 系统穿刺 经会阴 前列腺癌 

分 类 号：R737.25[医药卫生—肿瘤]