经直肠超声引导经会阴前列腺穿刺活检与经直肠前列腺穿刺活检的临床效果对比分析

Comparative Analysis of Clinical Effects of Transrectal Ultrasound-Guided Perineal Biopsy of Prostate and Transrectal Biopsy of Prostate

目的分析经直肠超声引导下经会阴前列腺穿刺活检术的临床结果。方法选取作者单位2019年1月至2019年12月收治的需行前列腺穿刺以及后续手术治疗患者共404例,其中符合研究价值的患者共385例,作为研究组,实施经直肠超声引导经会阴前列腺穿刺活检。并选取以往住院的385例侧卧位经直肠穿刺活检患者资料作为对照组。对比两组患者手术时间、出血量、不满意样本的针数以及疼痛程度;对比分析两组患者术后发热、直肠出血、疼痛、血尿、急性尿潴留等并发症发生率;同时将两组患者的穿刺结果与术后大病理结果进行对比分析,观察两组患者穿刺方法的准确度。结果研究组手术时间短于对照组(P=0.00),不满意样本数明显少于对照组(P=0.00),VAS疼痛评分低于对照组(P=0.01)。而出血量两组间差异无统计学意义(P=0.69);研究组手术并发症发生率为9%,对照组手术并发症发生率为13.75%,差异具有统计学意义(P=0.03);穿刺病例结果与术后大病理的对比分析显示,研究组符合率为91.48%,对照组符合率84.58%,差异无统计学意义(P=0.13);漏诊率研究组5.75%,对照组9.75%,差异无统计学意义(P=0.27)。结论截石位经直肠超声引导下经会阴前列腺穿刺活检术手术时间短,出血量少,标本采集满意率高,术后并发症发生率低,具有非常明显的优势,但与术后大病理的符合率及漏诊率二者相比并无显著性优势。

Objective To observe the clinical value of transperineal prostatebiopsy under the guidance of transrectal ultrasound at the lithotomy position. Methods A total of 385 patients who were hospitalized in our hospital from January 2019 to December 2019 who needed prostate puncture and followup surgery. As a research group, we performed transperineal prostate biopsy under the guidance of transrectal ultrasound at the lithotomy position. In addition, the data of 385 patients who had been hospitalized with lateral transrectal puncture biopsy were selected as the control group. The operation time, blood loss, number of needle supplements, number of needles of unsatisfactory samples, and pain degree were compared between the two groups of patients;the incidence of complications such as fever, rectal bleeding, pain, hematuria, and acute urinary retention were compared and analyzed between the two groups;The puncture results of the two groups of patients were compared and analyzed with the postoperative major pathological results, and the accuracy of the puncture methods of the two groups of patients was observed. Results The study group was significantly better than the control group in terms of operation time, number of needle supplements, number of needles of unsatisfactory samples, and VAS pain score(P<0.05). However, there was no significant difference in the amount of bleeding and the number of needles between the two groups(the amount of bleeding, P=0.69;thenumber of needles, P=0.43);the incidence of surgical complications in the study group was 9%, and the incidence of surgical complications in the control group 13.75%, the difference was statistically significant(P=0.03);there was no significant difference between the two puncture results at the two stages of PSA<4 and >10(P>0.05). Between 4~10 ng/ml, the positive rate of the transperineal puncture group was slightly higher than that of the control group, and the difference was statistically significant(P=0.04). The results of comparative analysis with postoperative major pathology showed that the study group was in line with Occupy a certain advantage in terms of rate and missed diagnosis rate, which is manifested by a high coincidence rate and a low missed diagnosis rate. But the difference between the two was not statistically significant(P>0.05). Conclusion The transperineal 9+χneedle biopsy of the prostate under the guidance of transrectal ultrasound at the lithotomy position has a short operation time, less blood loss, a high rate of sample collection satisfaction, a small number of needle supplements, and a low incidence of postoperative complications. Advantages, but there is no significant advantage compared with the coincidence rate and missed diagnosis rate of postoperative major pathology.