直肠超声引导下经会阴和经直肠途径穿刺置入标志物的比较和风险分析  

Comparison of marker implantation through trans-perineal or trans-rectal puncture guided by trans-rectal ultrasound and analysis of risks

作　　者：许蕊 范学武 田龙[1] 胡逸民[3] Xu Rui;Fan Xuewu;Tian Long;Hu Yimin(Department of Radiotherapy,the First Affiliated Hospital of Hebei Northern University,Zhangjiakou 075000,China;Cardiology Catheter Room,Hebei General Hospital,Shijiazhuang 050000,China;Department of Radiotherapy,Cancer Hospital Chinese Academy of Medical Sciences,Beijing 100021,China)

机构地区：[1]河北北方学院附属第一医院放疗科,张家口075000 [2]河北省人民医院导管室,石家庄050000 [3]中国医学科学院肿瘤医院放疗科,北京100021

出　　处：《国际泌尿系统杂志》2024年第2期247-251,共5页International Journal of Urology and Nephrology

基　　金：河北省医学科学研究课题计划项目(20190892);张家口市重点研发计划项目(1921002B)。

摘　　要：目的比较前列腺癌(PCa)图像引导放疗中直肠超声引导下经会阴穿刺(TPUS)与经直肠穿刺(TRUS)置入黄金基准标志物(GFM)的治疗效果,分析两种方法中不良事件(AE)的风险影响因素。方法前瞻性研究2017年8月至2021年12月间于河北北方学院附属第一医院接受诊疗的212例PCa患者的临床资料。采用抽签法将患者随机分为TPUS组(100例)和TRUS组(112例)。比较两组患者的疼痛、出血和感染情况,并对AE的风险影响因素行logistic回归分析。结果同TRUS组相比,TPUS组的卡氏评分(KPS)、新辅助雄激素剥夺治疗(ADT)、抗凝药物使用、前列腺体积<30 cm^(3)的患者例数较低,差异均有统计学意义(均P<0.05)。TPUS组的视觉模拟评分(VAS)≥4分和严重出血例数高于TRUS组,差异均有统计学意义(P=0.001、0.019)。TPUS组的总感染率(7.00%)低于TRUS组(9.82%)。VAS影响因素的单变量分析结果显示,年龄、前列腺体积、抗凝药物使用和ADT与VAS均有相关性(均P<0.05)。多变量分析结果显示,年龄≥60岁的PCa患者的VAS≥4分的风险提高了5.432倍(P=0.022)。严重出血影响因素的单变量分析结果显示,年龄、前列腺体积和抗凝药物使用与严重出血均有相关性(均P<0.05);而多变量分析结果显示,年龄≥60岁和前列腺体积≥30 cm3的患者发生严重出血的风险分别提高了4.702倍(P=0.015)和5.836倍(P<0.001)。结论TPUS和TRUS两种方法各有利弊,需根据患者自身情况选择合适的方法,并做好护理准备。Objective To compare the methods of the gold fiducial marker(GFM)implantation by the trans-rectal ultrasound-guided perineal puncture(TPUS)and the trans-rectal ultrasound-guided rectal puncture(TRUS),and to analyze the risk factors of the adverse event(AE)in image-guided radiotherapy for prostate cancer(PCa).Methods The collection of 212 PCa patients who were diagnosed and treated in the First Affiliated Hospital of Hebei North University from August 2017 to December 2021 was conducted for the prospective research.The patients were randomly divided into the TPUS group(100 cases)and the TRUS group(112 cases)by using the lot drawing method.The pain,bleeding and infection of the patients from the two groups were compared,and the risk factors of the AE were analyzed by using the logistic regression.Results Compared with TRUS group,the number of patients with Karnofsky score(KPS),androgen deprivation therapy(ADT),anticoagulant drug use and prostate volume<30 cm^(3)in TPUS group was lower,and the differences were statistically significant(all P<0.05).The number of patients with pain visual analogue score(VAS)≥4 scores and severe bleeding in the TPUS group was significantly higher than that in the TRUS group(P=0.001,0.019).The overall infection rate was lower in the TPUS group(7.00%)than in the TRUS group(9.82%).The univariate analysis of the influencing factors of VAS showed that there were statistically significant differences in age,prostate volume,anticoagulant use,and ADT between the two groups(all P<0.05).The results of multivariate analysis showed that PCa patients aged≥60 years had a 5.432 fold increased risk of VAS≥4 points(P=0.022).The univariate analysis results of factors affecting severe bleeding showed that there were statistically significant differences in age,prostate volume,and anticoagulant use between the two groups(all P<0.05).The multivariate analysis results showed that the risk of severe bleeding increased by 4.702 times(P=0.015)and 5.836 times(P<0.001)in patients aged≥60 years and with p

关 键 词：前列腺肿瘤 超声检查 穿刺术 会阴 直肠 

分 类 号：R737.25[医药卫生—肿瘤]