直肠超声引导下经会阴精囊腺穿刺活检术在评价前列腺癌临床分期中的意义

The significance of transrectal ultrasound guided transperineal seminal vesicle biopsy in evaluating the clinical stage of prostate cancer

目的 探讨直肠超声引导下经会阴精囊腺穿刺活检术在评价前列腺癌临床分期中的可行性和安全性.方法 回顾性分析2010年7月至2015年1月收治的57例伴有精囊异常的疑似前列腺癌患者的临床资料.年龄50 ～ 78岁,平均（65±7）岁.血清总前列腺特异性抗原（tPSA）3.2 ～ 131.1 μg/L,平均（23.7±11.3） μg/L.22例直肠指检可触及前列腺结节.结合MRI检查结果,临床分期均为T3b期.局麻下,57例均行超声及模板引导下经会阴前列腺及精囊腺分区穿刺活检,前列腺分为11区,每区穿刺1～4针;两侧精囊腺分别自外侧向中央穿刺3针,尽量靠近膀胱底部.穿刺组织送病理检查.结果 57例均顺利完成穿刺.穿刺病理检查发现前列腺癌44例,Gleason评分6～10分.其中累及精囊腺32例（阳性组）,肿瘤分期T3b期;未累及12例（阴性组）,肿瘤分期T2期.阳性组中20例行根治性前列腺切除术,术后病理诊断均提示前列腺癌累及精囊腺,术后病理分期为T3b期.阴性组中11例行根治性前列腺切除术,2例术后病理诊断提示累及精囊腺,肿瘤分期为T3b期.精囊腺穿刺敏感性为91％ （20/22）,特异性为100％ （9/9）,阳性预测值为100％（20/20）,阴性预测值为82％ （9/11）.57例穿刺后均无发热,发生肉眼血尿23例（40％）、血精20例（35％）、尿潴留1例（2％）,对症处理后症状消失.结论 直肠超声引导下经会阴精囊腺穿刺安全、可靠,有助于提高前列腺癌术前临床分期的准确率.

Objective To explore the safty and feasibility of transrectal ultrasound guided transperineal seminal vesicle biopsy in the evaluation of clinical staging of prostate cancer.Methods Retrospectively study 57 suspected prostate cancer patients with seminal abnormality during 2010.7-2015.1,age ranged from 50 to 78 years,average 65 ±7 years,serum total prostate specific antigen （tPSA） 3.2-131.1 μg/L, average （23.7 ± 11.3） μg/L.Twenty-two cases had palpable prostate nodules through rectal examination.All the 57 patients underwent ultrasound and template guided transperineal prostate and seminal vesicle puncture biopsies.Results Forty-four cases out of 57 found prostate cancer cells in biopsies, and 32 cases had seminal vesicle invasion （positive group） while the other 12 were negative.Twenty cases had been performed prostatectomy in the positive group and their post-operative pathological examination all showed prostate cancer with seminal vesicle invasion.Eleven cases in the negative group had been performed prostatectomy ,and 2 cases showed seminal vesicle invasion.The clinical stages of all cases in the positive group were considered as T3b both pre-operatively and post-operatively.In the negative group however, 11 cases were considered as T2 stage pre-operatively,while 2 cases were increased to T3b stage post-operatively.The sensitivity of puncturing seminal vesicle was 91% （20/22） ,specificity was 100.0% （9/9）.Positive predictive value was 100.0% （20/20）,while negative predictive value was 82% （9/11）.All the 57 cases did not present fever after puncture biopsies, while 23 cases presented hematuria （40%） ,20 cases presented hemospermia （35%） and 1 case presented urinary retention （2%）.Conclusions Transrectal ultrasound-guided transperinealseminal vesicle puncture is safe and reliable, it helps to improve the accuracy of pre-operative staging.