前列腺活检组织快速冰冻病理检查结合RP诊治前列腺癌的可行性和安全性  

Feasibility and safety of rapid frozen pathological examination of prostate biopsy tissue combined with RP in the diagnosis and treatment of prostate cancer

作　　者：朱良勇 丁雪飞[1] 肖芹[2] 陈骥[3] 栾阳[1] 黄天宝[1] 卢圣铭[1] 陈昊鹏 韩悦星 刘中 Zhu Liangyong;Ding Xuefei;Xiao Qin;Chen Ji;Luan Yang;Huang Tianbao;Lu Shengming;Chen Haopeng;Han Yuexing;Liu Zhong(Department of Urology,Northern Jiangsu People's Hospital,Yangzhou 225001,China;Department of Pathology,Northern Jiangsu People's Hospital,Yangzhou 225001,China;Department of Imaging,Northern Jiangsu People's Hospital,Yangzhou 225001,China)

机构地区：[1]江苏省苏北人民医院泌尿外科,扬州225001 [2]江苏省苏北人民医院病理科,扬州225001 [3]江苏省苏北人民医院影像科,扬州225001

出　　处：《中华泌尿外科杂志》2022年第8期593-597,共5页Chinese Journal of Urology

摘　　要：目的探讨前列腺活检组织快速冰冻病理检查与根治性前列腺切除术(RP)相结合用于前列腺癌诊治的可行性和安全性。方法收集2021年4—9月苏北人民医院PSA>10 ng/ml且前列腺影像报告和数据系统(PI-RADS)评分均≥4分的可疑前列腺癌患者。采用16G活检针行mpMRI/经直肠超声图像融合引导下经会阴前列腺靶向活检,每例患者活检2~3针,活检组织行快速冰冻病理检查。对快速冰冻病理诊断为前列腺癌者立即行机器人辅助腹腔镜根治性前列腺切除术(RALP);对不能诊断前列腺癌者,应用18G活检针行前列腺靶向+系统活检,系统活检18~22针,行常规病理检查。记录患者的基线数据、冰冻病理检查结果、围手术期情况、术后病理结果和随访资料。结果本研究共纳入11例患者,平均年龄69.9(66~73)岁。平均体质指数22.8(19~26)kg/m^(2)。平均前列腺特异性抗原(PSA)23.2(14.25~32.00)ng/ml,平均前列腺体积45(32~52)ml,平均PSAD 0.54(0.33~0.75)。PI-RADS评分4分3例、5分8例。直肠指检阳性5例。11例活检组织快速冰冻病理检查结果中9例为前列腺腺癌,立即行RALP,手术时间111.5(96~126)min;术中出血量78.9(55~105)ml;术后盆腔引流管拔除时间4.3(3.5~5.0)d;术后住院时间5.8(5.0~6.5)d。术后病理Gleason评分3+4=7分1例,4+3=7分3例,8分4例,10分1例;3例切缘阳性,1例精囊侵犯;清扫淋巴结数量平均10.9(8.5~14.0)枚,均无肿瘤转移;病理T分期为T_(2b)期2例,T_(2c)期5例,T_(3a)期1例,T_(3b)期1例。2例快速冰冻病理检查不能诊断者,其中1例常规病理诊断为前列腺腺癌,Gleason评分4+3=7分,后接受RALP;1例常规病理诊断为前列腺炎症。11例均获得随访,平均随访时间5.2(3~7)个月。10例行RALP患者中,8例术后2周恢复尿控,2例术后2个月恢复尿控。3例切缘阳性患者于术后第2周规律行雄激素剥夺治疗。术后3个月1例切缘阳性和精囊受侵犯患者的PSA未降至0.1 ng/ml以下,余9例PSA均<0.1Objective To explore the feasibility and safety of the clinical application of the diagnosis and treatment mode combining rapid frozen pathological examination of prostate biopsy tissue with radical prostatectomy.Methods Suspected prostate cancer patients with PSA>10 ng/ml and PI-RADS score≥4 in,Northern Jiangsu People's Hospital from April to September 2021 were collected.The included patients underwent mpMRI/TRUS image fusion-guided transperineal prostate targeted biopsy with 16G biopsy needle,2-3 needles for biopsy,and rapid frozen pathological examination.Robot-assisted laparoscopic radical prostatectomy(RALP)was performed immediately for patients with prostate cancer with rapid freezing pathology.For undiagnosed prostate cancer,18G biopsy needle for prostate targeted+systematic biopsy were used,18-22 needles for systematic biopsy,and routine pathological examination.The baseline data,frozen pathological results,perioperative conditions,pathological results and follow-up data of all patients were collected.Results Eleven patients were included in the study,the mean age of the patients was 69.9(66-73)years,the mean BMI was 22.8(19-26)kg/m^(2),the mean PSA was 23.2(14.25-32.00),the mean prostate volume was 45(32-52)ml,mean PSAD 0.54(0.33-0.75).PI-RADS score was 4 in 3 cases and 5 in 8 cases;digital rectal examination was positive in 5 cases.All 11 cases underwent rapid freezing and the pathological results showed that:9 cases were prostate adenocarcinoma,and RALP was performed immediately.The operation time was 111.5(96-126)min,the intraoperative blood loss was 78.9(55-105)ml,and the postoperative extubation time was 4.3(3.5-5.0)days,postoperative hospital stay 5.8(5.0-6.5)days.Postoperative pathology showed that Gleason score 3+4=7 in 1 case,4+3=7 in 3 cases,8 points in 4 cases,and 10 points in 1 case;3 cases had positive resection margins,and 1 case had seminal vesicle invasion,the average number of dissected lymph nodes was 10.9(8.5-14.0),and there was no tumor metastasis.Pathological T staging included 2

关 键 词：前列腺肿瘤 前列腺癌 快速冰冻病理检查 根治性切除 诊治 

分 类 号：R737.25[医药卫生—肿瘤]