腹腔镜探头经直肠超声引导下行经会阴前列腺穿刺活检术的初步探讨

Preliminary study on TRUS guided transperineal prostate biopsy with laparoscopic probe

目的探讨腹腔镜线阵探头在经直肠超声引导下行经会阴前列腺穿刺活检术中的应用价值。方法对因前列腺直肠指检发现结节、血清PSA水平高于正常值(如PSA>4μg/L)、超声或其他影像学检查发现前列腺占位病变、发现转移癌,怀疑原发灶在前列腺的72例疑似前列腺癌患者,将腹腔镜线阵探头前方涂抹较多超声耦合剂外套避孕套后放入直肠内行经直肠超声引导下经会阴前列腺穿刺活检术,分析其临床资料和声像图表现。结果 (1)本组72例均取材满意,经病理证实前列腺癌24例;前列腺增生41例;前列腺炎4例;不典型增生3例。(2)腹腔镜探头经直肠检查刺激小、易接受,可清晰显示直肠壁、前列腺(尤其外腺)及其周围组织结构的声像图。(3)腹腔镜线阵探头经直肠超声引导下的穿刺活检术可清晰显示穿刺针针尖的位置及穿刺活检的动态过程。结论在经会阴前列腺穿刺活检术中运用腹腔镜线阵探头经直肠超声引导是一种易被患者接受的、既能提高前列腺病灶、穿刺针针尖及针道超声显示的清晰度,又能有效减少穿刺活检术盲目性的方法。

Objective To investigate the value of laparoseopic linear probe in transrectal ultrasound （TRUS） guided transperineal prostate biopsy. Methods A total of 72 patients, who were suspected of prostate tumor due to nodules via digital rectal examination, abnormal increase in PSA level （ 〉 4 μg/L） , prostate-occupying lesions by ultrasound or other imaging means, and metastatic carcinoma from prostate, underwent transperineal prostate biopsy under TRUS guidance through laparoscopic probe. The clinical data and sonographie performance were analyzed retrospectively. Results （ 1 ） Out of the 72 cases of pathological examination, 24 were confirmed as prostate cancer, 41 as prostatic hyperplasia, 4 as prostatitis and 3 as atypical hyperplasia. （2） Laparoscopic probe rectal examination was easy to be accepted, and clearly showed the sonograms of rectal wall, prostate （ especially the outer gland） and its surrounding structures. （3） The laparoscopie linear array probe after TRUS guided aspiration biopsy clearly showed the location of the needle tip and the dynamic process of biopsy. Conclusion TRUS guided transperineal prostate biopsy with Laparoscopic probe is a method easily accepted by patients, and can effectively reduce the needle biopsy blindness.