经会阴前列腺穿刺活检术单中心经验总结(附2722例患者报告)  

Experiences of transperineal prostate biopsy in single center(report of 2722 patients)

作　　者：瞿旻[1] 李沪生 王海峰[1] 王燕[1] 高旭[1] Qu Min;Li Husheng;Wang Haifeng;Wang Yan;Gao Xu(Department of Urology,Changhai Hospital Affiliated to the Second Military Medical University,Shanghai 200433,China)

机构地区：[1]第二军医大学附属长海医院泌尿外科,上海200433

出　　处：《中华腔镜泌尿外科杂志（电子版）》2021年第6期458-462,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：上海市科技青年英才扬帆人才计划(19YF1447000)。

摘　　要：目的回顾性描述我中心经会阴前列腺穿刺术,挖掘影响穿刺阳性率的关键因素,比较单纯系统穿刺及系统联合靶向穿刺的差异。方法纳入2017年6月至2019年12月在我中心行经会阴前列腺穿刺术患者,共2722例。使用t检验和χ2检验比较计量和计数资料,使用Logistic回归模型分析影响穿刺阳性率的关键因素。结果收治患者平均年龄为(67±8)岁,BMI(24.3±3.0)kg/m^(2),中位PSA 11.59 ng/ml。患者中有190例既往接受过穿刺(6.9%,190/2722)。有933例患者接受了系统联合靶向穿刺术(34.3%,933/2722)。术后有60例患者发生严重并发症(2.20%,60/2722)。病理结果提示有1439例明确诊断前列腺腺泡腺癌,穿刺阳性率52.8%(1439/2722)。通过Logistic回归模型分析发现患者年龄>70岁(OR=3.67,2.55~5.30,P<0.01)、PSA>20 ng/ml(OR=35.83,19.02~67.48,P<0.01)以及进行靶向联合系统穿刺(OR=2.89,2.39~3.48,P<0.01)是前列腺癌确诊的关键因素。进一步比较单纯系统穿刺与系统联合靶向穿刺的差异,发现联合靶向组中PSA<20 ng/ml的患者例数显著高于单纯系统组(83.9%vs 65.7%,P<0.01)。联合靶向组患者既往穿刺病史比例更高(12.2%vs 4.2%,P<0.01),且联合靶向组穿刺阳性率更高(64.0%vs 47.1%,P<0.01)。结论经会阴前列腺穿刺术安全有效。患者高龄、高PSA水平以及实施靶向穿刺术是前列腺癌确诊的关键因素。多参数磁共振指导的系统联合靶向穿刺可提高穿刺阳性率,尤其在低PSA及重复穿刺的前提下建议进行多参数磁共振指导的靶向穿刺。Objective To retrospectively describe the transperineal prostate puncture in our center,explore the key factors affecting the positive rate of puncture,and compare the differences between simple systematic puncture and systematic combined targeted puncture.Methods A total of 2722 patients who underwent transperineal prostate puncture in our center from June 2017 to December 2019 were included.Measurement and enumeration data were compared using t tests and chi-square tests,and logistic regression models were used to analyze the key factors affecting the positive rate of puncture.Results The average age was(67±8)years,the average BMI was(24.3±3.0)kg/m^(2),and the median PSA was 11.59 ng/ml.190 patients(6.9%,190/2722)had a prior puncture.There were 933 patients who underwent systematic and targeted puncture(34.3%,933/2722).Postoperative major complications occurred in 60 patients(2.20%,60/2722).Pathological results showed that 1439 cases were definitely diagnosed as prostatic acinar adenocarcinoma,and the positive rate of puncture was 52.8%(1439/2722).Logistic regression analysis showed that age>70 years(OR=3.67,2.55-5.30,P<0.01),PSA>20 ng/ml(OR=35.83,19.02-67.48,P<0.01)and targeted combined systematic puncture(OR=2.89,2.39-3.48,P<0.01)were the key factors for the diagnosis of prostate cancer.Further comparison of the difference between systematic puncture alone and systematic combined targeted puncture revealed that the number of patients with combined targeted PSA<20 ng/ml was significantly higher than that in the systematic puncture alone group(83.9%vs 65.7%,P<0.01).The proportion of patients with previous puncture history was higher in the combined targeted group(12.2%vs 4.2%,P<0.01).The combined targeting group significantly increased the positive rate of puncture(64.0%vs 47.1%,P<0.01).Conclusion Transperineal prostate puncture is safe and effective.Age,high PSA levels,and targeted paracentesis are key factors in the diagnosis of prostate cancer.Multi-parameter MR-guided targeted puncture can improve the pos

关 键 词：前列腺癌 穿刺活检 

分 类 号：R737.25[医药卫生—肿瘤]