模板定位下经会阴前列腺穿刺活检在经直肠途径初次活检阴性患者检查中的应用

The application of the template positioning transperineal prostate biopsy in the first prostate biopsynegative patients

目的探讨模板定位下经会阴前列腺穿刺活检术在对经直肠前列腺穿刺活检阴性患者检查中的有效性及安全性。方法收集2010年1月至2012年1月经直肠前列腺穿刺活检阴性患者42例。年龄50～81岁，平均67岁。PSA0．9～27．3μg／L，平均13．1μg／L。人组条件：曾行前列腺穿刺活检≥1次，结果为阴性或前列腺上皮内瘤（PIN）或非典型小细胞腺泡样增生（AAH），但术后tPSA仍〉10μg／L和（或）PSA速率仍〉0．75μg／L。取膀胱截石位，会阴部皮下及前列腺尖部包膜浸润麻醉下，行经直肠超声引导下模板定位经会阴前列腺穿刺活检术。分析模板定位下经会阴前列腺穿刺活检术的阳性率、影响因素及并发症。结果本组行前列腺穿刺16—44针，平均18．7针。穿刺阳性率为44％（19／42），Gleason评分4～9分，平均6分。穿刺阳性者前列腺体积27～67ml，平均44ml；阴性者37～104ml，平均71ml，两组比较差异有统计学意义（P〈0．05）。穿刺阳性率与患者是否为PIN和AHH、前列腺穿刺针数、PSA值无相关性（P〉0．05）。穿刺阳性者前列腺癌在移行区的发生率为74％（14／19），其中36％（5／14）只发生在移行区。穿刺后1周内血尿发生率为29％（12／42），尿潴留发生率为9％（4／42），无严重感染等并发症发生。结论模板定位下经会阴前列腺穿刺活检术诊断经直肠途径初次活检阴性患者安全、有效。

Objective To assess the safety and efficiency of systematic transperineal ultrasound guided template positioning biopsy for the high-risk population of prostate cancer. Methods From January 2010 to January 2012 a total of 42 high-risk men of prostate cancer underwent systematic ultrasound guided biopsy using the transperineal template positioning technique. All patients got at least one previous biopsy, and all the patients showed negative results, including prostatic intraepithelial neoplasia, and/or atypical small cell acinar proliferation. During the follow-up, all the patients still had high prostate specific antigen （PSA） velocity （ 〉 0. 75μg/L） or high PSA level （ 〉 10 μg/L）. Results A mean of 18.7 biopsy cores had been obtained. Cancer was identified in 19 of the 42 men （44%）. The mean Gleason score was 6 （from 4 to 9）. Mean prostate volume in the positive and negative biopsy groups was 44 and 71 ml. The only significant independent influence factor for positive biopsy was prostate volume （ P 〈 0.05）. The positive rate showed no statistic difference in term of presence of PIN, AHH, the number of biopsy sites,or PSA val- ue （P 〉0.05）. Adenocarcinoma was found in transition zone in 14 of 19 cases （74%）, and 5 （36%） was positive only in the transition zone. Complications were rare and self-limiting, including hematuria （29%）and urinary retention （0.9%）. Conclusions Systematic transperineal template positioning biopsy of the prostate is a safe and precise biopsy technique in patients who remain at high-risk for prostate adenocarcinoma.