经会阴前列腺穿刺活检漏诊原因分析（附4例报告）

Analysis of the cause of missed diagnosis in transperineal prostate biopsy with 4 cases report

目的探讨直肠超声引导下经会阴前列腺穿刺活检漏诊的原因。方法回顾性分析2012年1月至2014年12月苏北人民医院行直肠超声引导下经会阴前列腺穿刺活检的患者共278例，采用前列腺11分区法系统穿刺。结果穿刺活检病理诊断前列腺癌129例，前列腺增生149例。穿刺阴性患者中56例合并明显下尿路梗阻症状，行经尿道前列腺电切术（TURP），术后发现前列腺癌4例，其中2例行前列腺癌根治术，2例选择内分泌治疗。4例患者随访复查前列腺特异抗原（PSA）水平下降且控制满意，1例患者随访9个月后出现PSA升高，随访过程中无死亡病例。结论早期前列腺癌，肿瘤位置特殊，穿刺组织不足，特殊患者体位受限，麻醉不满意等因素可能增加漏诊风险，可寻求靶向及个体化穿刺以提高穿刺效力。

Objective To investigate the causes of missed diagnosis in transrectal ultrasound-guided transperineal prostate biopsy. Methods The biopsy results of total 278 patients who received transrectal ultrasound-guided trausperineal prostate biopsy from January 2012 to December 2014 in Subei People＇ s Hospital were retrospectively analyzed, using 11 systemic divisions. Results One hundred and twenty-nine patients were diagnosed with prostate cancer, and 149 patients were hyperplasia of prostate. Fifty-six patients with biopsy-negativeand obvious symptoms of lower urinary tract obstruction were underwent transurethral resection of the prostate. Four of which were found to be prostate cancer. Conclusion Early-stage prostate cancer, special prostate tumor location, inadequate biopsy tissue, special patients in limited position, and dissatisfied anesthesia may increase the risk of missed diagnosis. Targeted and individualized puncture may improve the effectiveness.