经直肠超声造影辅助前列腺穿刺活检与前列腺系统穿刺活检的比较研究

A comparative study of transrectal contrast-enhanced ultrasound assisted prostate biopsy and system-ic prostate biopsy

目的：比较经直肠超声造影辅助前列腺穿刺活检和前列腺系统穿刺活检的穿刺效率。方法2010年1月至2011年12月采用简单随机抽样方法选择213例可疑前列腺癌患者，在经直肠超声造影辅助下，针对造影异常区域行前列腺穿刺活检（造影穿刺组），年龄54～83岁，平均（71．0±8．9）岁。 PSA 4．1～150．0μg/L，平均（22．5±19．4）μg/L。直肠指检触及结节或质地不均者119例（55．9％），经直肠超声检查发现异常结节或回声不均质者80例（37．6％）。相同随机方法选择同期218例可疑前列腺癌患者行前列腺系统穿刺活检（系统穿刺组），年龄36～94岁，平均（65．0±9．1）岁。 PSA 4．6～147．0μg/L，平均（23．3±18．9）μg/L，经直肠超声检查发现异常结节或回声不均质者125例（57．3％），经直肠超声检查发现异常结节或回声不均质者83例（38．1％）。两组的PSA、前列腺体积、直肠指检阳性率及经直肠超声检查阳性率比较差异均无统计学意义（ P＞0．05）。比较两组的穿刺针数、单针阳性率、Gleason评分等。结果造影穿刺组与系统穿刺组比较，前列腺癌阳性率分别为38．0％（81/213）和34．9％（76/218），差异无统计学意义（P＞0．05）；人均穿刺针数分别为9．5针和12．0针，差异有统计学意义（P＜0．05）；单针阳性率分别为18．2％（369/2025）和11．5％（301/2616），差异有统计学意义（ P＜0．05）；Gleason评分分别为7．1分和6．6分，差异有统计学意义（ P＜0．05）。

Objective To evaluate the advantages of transrectal contrast-enhanced ultrasound assis-ted prostate biopsy by comparing with systemic prostate biopsy . Methods From Jan.2010 to Dec.2011, 213 cases were selected randomly.Patient＆#39;s mean age was 71.0±8.9 （54-83） years.Their PSA level was 22.5±19.4 （4.1-150.0） μg/L.The positive rates of DRE and transrectal ultrasound were 55.9%（ 119/213） and 37.6%（80/213）.This group of patients were biopsied according to transrectal contrast-enhanced ultrasound assisted prostate biopsies （ experimental group ） .During the same period , another 218 cases were selected randomly.Patient′s mean age was 65.0±9.1 （36-94） years.Their PSA level was 23.3±18.9 （4.6-147.0） μg/L.The positive rates of DRE and transrectal ultrasound were 57.3%（ 125/218 ） and 38.1%（83/213）.This group of patients were biopsied according to systemic prostate biopsy （control group）.The data of two groups were compared to find out the advantages and disadvantages of transrectal contrast -en-hanced ultrasound assisted prostate biopsy . Results Comparing these two groups , the positive rates of prostate cancer in experimental group and control group were 38.0%（81/213） and 34.9%（76/218）, with no statistically significance （ P〉0.05）; the numbers of cores were 9.5 and 12.0, with statistically signifi-cance （P〈0.05）;the positive rates of single needle were 18.2%（369/2 025） and 11.5%（301/2 616）, with statistically significance （P〈0.05）; and the mean Gleason scores were 7.1 and 6.6, with statistically significance （P〈0.05）. Conclusions The efficiency of transrectal contrast-enhanced ultrasound assisted prostate biopsy is higher than systemic prostate biopsy .Transrectal contrast-enhanced ultrasound assisted prostate biopsy can be considered as a new option for prostate biopsy .