经会阴前列腺靶向联合系统活检的并发症分析  

Analysis in complications of transperineal targeted combination systematic biopsy for prostate

作　　者：周训荣[1] 贲春生 武程[1] 姚宏伟 常平安[1] 王力冬 夏安乐[1] ZHOU Xunrong;BEN Chunsheng;WU Cheng;YAO Hongwei;CHANG Ping′an;WANG Lidong;XIA Anle(Department of Urinary Surgery,Dongtai City People′s Hospital of Jiangsu Province,Yancheng,Jiangsu,224200)

机构地区：[1]江苏省东台市人民医院泌尿外科,江苏盐城224200

出　　处：《实用临床医药杂志》2023年第20期21-25,共5页Journal of Clinical Medicine in Practice

基　　金：江苏省卫生健康委员会科研项目(Z2021050)。

摘　　要：目的分析经会阴前列腺靶向联合系统活检的并发症发生情况。方法回顾性分析2019年1月—2022年5月在东台市人民医院泌尿外科行经会阴前列腺活检患者的临床资料。根据前列腺影像报告和数据系统(PI-RADS)评分,将患者分为系统活检组(PI-RADS评分<3分)和靶向联合系统活检组(PI-RADS评分≥3分)。收集患者的一般临床资料和活检后感染、血尿、会阴部血肿、尿潴留、下尿路症状、迷走神经反射等发生情况;比较2组患者前列腺活检相关并发症的发生情况。结果本研究共纳入432例患者,其中靶向联合系统活检组292例,系统活检组140例。靶向联合系统活检组的年龄、前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)及体质量指数(BMI)高于系统活检组,前列腺体积小于系统活检组,差异有统计学意义(P<0.05或P<0.01)。靶向联合系统活检组活检针数为(15.6±1.1)针,多于系统活检组的(13.2±0.8)针,差异有统计学意义(P<0.01)。432例患者总体活检阳性率为46.5%(201/432),临床显著性前列腺癌(csPCa)率为38.0%(164/432)。靶向联合系统活检组阳性率、csPCa率依次为59.6%(174/292)、52.4%(153/292),高于系统活检组的19.3%(27/140)、7.9%(11/140),差异有统计学意义(P<0.01)。在血尿及其严重程度、血精、感染、尿潴留及迷走神经反射等并发症方面,靶向联合系统活检组的发生率均高于系统活检组,但差异无统计学意义(P>0.05)。靶向联合系统活检组会阴部血肿总发生率为21.57%,系统活检组为17.14%,差异无统计学意义(P>0.05),但靶向联合系统活检组的中度及重度会阴部血肿发生率高于系统活检组,差异有统计学意义(P<0.01)。经观察发现保守治疗后血肿吸收,未出现Clavien分级>Ⅰ级的手术并发症。结论靶向联合系统活检提高了活检的准确性,虽然其增加了中重度血肿的发生率,但仍是一种安全的活检方式。Objective To analyze the incidence of complications in patients with transperineal targeted combination systematic biopsy for prostate.Methods Clinical materials of patients with transperineal biopsy for prostate in the Department of Urinary Surgery of the Dongtai City People's Hospital from January 2019 to May 2022 were retrospectively analyzed.According to the Prostate Imaging Reporting and Data System(PI-RADS)score,the patients were divided into systematic biopsy group(PI-RADS score<3)and targeted combination systematic biopsy group(PI-RADS score≥3).General clinical materials and incidence conditions of post-biopsy complications such as infection,hematuria,perineal hematoma,urinary retention,lower urinary tract symptoms,and vagal nerve reflex were collected;the occurrence of prostate biopsy related complications were compared between the two groups.Results A total of 432 patients were enrolled in this study,with 292 cases in the targeted combination systematic biopsy group and 140 cases in the systematic biopsy group.The age,prostate specific antigen(PSA),prostate specific antigen density(PSAD)and body mass index(BMI)in the targeted combination systematic biopsy group were significantly higher than those in the systematic biopsy group,while the prostate volume was significantly smaller than that in the systematic biopsy group(P<0.05 or P<0.01).The number of biopsy needles in the targeted combination systematic biopsy group was(15.6±1.1),which was significantly higher than(13.2±0.8)in the systematic biopsy group(P<0.01).The overall positive rate of biopsy in 432 patients was 46.5%(201/432),and the incidence rate of clinically significant prostate cancer(csPCa)was 38.0%(164/432).The positive rate and incidence rate of csPCa in the targeted combination systematic biopsy group were 59.6%(174/292)and 52.4%(153/292)respectively,which were significantly higher than 19.3%(27/140)and 7.9%(11/140)in the systematic biopsy group(P<0.01).In terms of complications such as hematuria and its severity,hemospermia,infection

关 键 词：前列腺癌 靶向活检 系统活检 并发症 会阴部血肿 

分 类 号：R697[医药卫生—泌尿科学] R446.1[医药卫生—外科学]