经直肠超声引导在前列腺13点法穿刺活检中的临床应用价值

Clinical application value of trans-rectal ultrasonic guidance in prostatic puncture biopsy by 13 points method

目的探讨直肠超声引导在前列腺13点法穿刺活检术中的临床应用价值,提高诊断阳性率。方法对108例具有前列腺穿刺指征患者行超声引导下前列腺穿刺术,并分析临床资料。结果 108例患者均取材成功,成功率为100%。病理结果显示前列腺癌60例(55.56%)和良性前列腺增生48例(44.44%)。术后肛门滴血6例、尿道出血2例,无严重并发症发生。65例经直肠超声检查发现前列腺结节者,诊断与病理符合率为83.08%;43例未检出结节,符合率为51.16%,差异存在统计学意义(P<0.05)。穿刺前超声检查发现结节者,超声诊断灵敏度为89.36%,显著高于无结节者的30.77%,差异有统计学意义(P<0.05);但二者特异度相似,差异无统计学意义(P>0.05)。随着前列腺癌病理分级的升高,其血清中PSA浓度也相应升高,呈正相关(P<0.05)。结论经直肠超声引导下行前列腺13点穿刺活检术,穿刺成功率高、术后并发症少、有助于前列腺疾病的定性诊断,值得临床推广应用。

Objective To explore the clinical application value of trans-rectal ultrasonic guidance in prostatic puncture biopsy by 13 points method,and to elevate diagnostic positive rate.Methods Prostatic puncture was conducted in 108 patients who were indicated in prostatic puncture and the clinical data was analyzed.Results All the 108 patients were successfully biopsied,with an achievement ratio of 100%.The pathologic results revealed that 60 patients had carcinoma of prostate（55.56%） and 48 patients had benign prostatic hyperplasia（44.44%）.After the surgery,6 patients experienced anal staxis and 2 experienced urethremorrhage,and no severe complication occurred.In 65 patients with prostatic tubercles discovered by trans-rectal ultrasonography,the coincidence between the diagnosis and the pathologic findings was 83.08%;while in 43 patients,no tubercle was detectable,and the coincidence was 51.16%;the difference was significance（P0.05）.In patients with tubercles discovered by ultrasonography before the puncture,the diagnostic sensitivity of ultrasound was 89.36%,was significantly higher than that in patients without tubercles（30.77%）,and the difference was of statistical significance（P0.05）;But the specificities in patients with and without tubercles were similar and the difference had no statistical significance（P0.05）.Following the increase of the pathologic classification of carcinoma of prostate,serum PSA concentration was corresponding increased,which were positively correlated（P0.05）.Conclusion Trans-rectal ultrasonic guidance in prostatic puncture biopsy by 13 points method has advantages of high puncture achievement ratio and few postoperative complications,was helpful for the qualitative diagnosis of prostatic diseases and was worthy of clinical generalization and application.