直肠超声引导下经会阴与经直肠前列腺穿刺活检术诊断前列腺癌的临床价值比较

Comparison of the clinical value of transperineal and transrectal prostate biopsy guided by transrectal ultrasonography in diagnosis of prostate cancer

目的比较直肠超声引导下经会阴与经直肠前列腺穿刺活检术诊断前列腺癌的临床价值。方法回顾分析本院行直肠超声引导下经会阴前列腺穿刺活检术的175例患者与经直肠前列腺穿刺活检术的137例患者资料,比较两组患者的术前资料、前列腺癌阳性检出率及安全性。结果两组患者的血清PSA、前列腺结节检出率及前列腺体积无明显差别,经会阴穿刺患者的前列腺癌阳性检出率为41.14%,并发疼痛、发热、血尿及尿潴留的患者分别占9.14%、3.43%、6.86%和5.71%,无患者发生血便。经直肠穿刺患者的前列腺癌阳性检出率为39.42%,并发疼痛、发热、血尿、尿潴留及血便的患者分别为8.03%、9.49%、8.03%、5.84%和5.11%;两种方法比较,经会阴穿刺术后患者发热及血便的发生率明显低于经直肠穿刺的患者,而前列腺癌阳性检出率、术后疼痛、血尿和尿潴留的发生率无明显差异。结论经直肠超声引导下的经会阴穿刺和经直肠穿刺前列腺活检术都是有效的活检方法。应根据患者直肠指检是否扪及肿块、TRUS是否发现占位及患者身体状况来选择穿刺方法。有感染倾向的患者应选择经会阴穿刺活检。

[ Objective ] To compare the clinical value of transperineal and transrectal prostate biopsy guided by transrectal uhrasonography in diagnosis of prostate cancer. [Methods] 175 and 137 patients underwent transperineal and transrectal prostate biopsy, respectively. Retrospective analysis their materials, and compared their preoperation data, positive rate of prostate cancer and safety. [ Results ] There was no significant difference of serum PSA, positive rate of nodules and prostatic volume of these two groups. The positive rate of prostate cancer of patients underwent transperineal prostate biopsy was 41.14%, and the complication rate of pain, fever, hematuria and urinary retention were 9.14%, 3.43%, 6.86% and 5.71% respectively, while the positive rate of prostate cancer in patients underwent transperineal prostate biopsy were 41.14%, and the complication rate of pain, fever, bematuria, urinary retention and bloody stools were 8.03%, 9.49%, 8.03%, 5.84% and 5.11%, respectively. The complication rate of fever and bloody stools of patients underwent transperineal prostate biopsy were significant lower than patients underwent transreetal prostate biopsy （P 〈0.05）, but the positive rate of prostate cancer, pain, hematuria and urinary retention were similar （P 〉0.05）. [ Conclusions ] Both of transperineal and transrectal prostate biopsy guided by transrectal ultrasonography were effective way for diagnosis prostate cancer. The result of DRE, TURS and patients＇ condition should be considered to choosing appropriate way for biopsy. Transperineal biopsy was recommended when patients might be associated with symptoms of infection