经会阴B型超声引导下前列腺穿刺活检的临床价值研究

Clinical Value of Ultrasound Guided Transperineal Prostate Biopsy in Detecting Prostate Cancer

目的: 探讨经会阴扇型B型超声引导下前列腺6针穿刺活检术诊断前列腺癌的临床价值. 方法: 对经直肠指检或经腹部B超检查发现前列腺结节、血清总前列腺特异性抗原(tPSA)在4 μg/L以上或游离PSA(fPSA)/tPSA<0.16的可疑前列腺癌104例患者,经会阴扇型B超引导下18G自动穿刺活检针行双侧叶6点法穿刺,对穿刺的阳性率和并发症及影响穿刺阳性率的因素进行分析. 结果: 经病理诊断,检出前列腺癌24例,检出率23%,前列腺癌分级评分中位数为7分,高分化癌(2～4分)、中分化癌(5～7分)和低分化癌(8～10分)分别为12.5%(3/24)、62.5%(15/24)和25%(6/24);其余80例为良性前列腺增生(BPH).术后短暂和轻度的肉眼血尿5例(4.8%),均在1～3 d后缓解,4例(3.8%)发热37.2 ℃～38.0 ℃,术后会阴部轻度不适5例(4.8%).术后无1例出现血便、血精、前列腺脓肿、高热、败血症、急性尿潴留等严重并发症.经分析发现tPSA、fPSA、fPSA/tPSA、前列腺抗原密度(PSAD)和前列腺体积是影响前列腺穿刺阳性率的重要因素(P<0.05),经会阴穿刺优势主要反映在tPSA≥10 μg/L、fPSA≥2 μg/L、fPSA/tPSA<0.16、PSAD≥0.2和前列腺体积<40 ml时提示应行会阴穿刺术. 结论: 经会阴扇型B型超声引导下6针前列腺穿刺活检,是一种安全准确的前列腺癌检出方法.

Objective： To report our experience of ultrasound guided transperineal 6-core prostate biopsy （UG6CPB） in the diagnosis of prostate cacer （PCa）. Methods： In a prospective study, we performed UC,6CPB in 104 suspected PCa patients with tPSA more than 4 μg/L and analysed the positive rate and complications of the diagnostic approach. Results： PCa was detected in 24 of the 104 patients （23%）, with low grade Gleason 2 to 4 in 3 cases （ 12.5% ）, intermediate grade Gleason 5 to 7 in 15 （62.5%） and high grade Gleason 8 to 10 in the remaining 6 （25%）. Complications included temporary hematuria in 5 patients （4.8%） , mild postbiopsy perineal discomfort in 5 （4.8%）and fever in 4 （3.8%）. TPSA≥10 μg/L, fPSA≥2 μg/L, fPSA/tPSA 〈 0.16, PSAD≥0.2 and prostate volume 〈 40 ml were the significant influencing factors of biopsy positive rate（ P 〈 0.05 ）. Conclusion ： UG6CPB is an exact and a safe way of detecting PCa. Natl J Androl,2005,11 （11） ：828-831