经直肠超声引导下12＋X前列腺穿刺法诊断前列腺癌的优势性分析

The davantages of transrectal ultrasound-guided 12 ＋ X-core biopsy in the diagnosis of prostate cancer

目的 探讨经直肠超声引导下12＋X前列腺穿刺法在前列腺癌诊断中的作用和意义,以及影响前列腺癌穿刺阳性率的相关因素.方法 回顾性分析2010年1月至2016年3月622例接受经直肠超声引导下12＋X前列腺穿刺患者的临床资料.年龄46～88岁,平均（68.1±6.8）岁,其中≤60岁者116例,61 ～ 70岁者251例,71 ～ 80岁者230例,＞80岁者25例.PSA 0.35～264.00 ng/ml,平均（28.15±31.42） ng/ml,其中＜4 ng/ml 26例,4～9 ng/ml 82例,10 ～ 19 ng/ml 194例,20 ～ 39ng/ml 93例,40 ～ 59 ng/ml 34例,60 ～ 79 ng/ml 32例,80 ～99 ng/ml 66例,≥100 ng/ml 5例.分析患者不同年龄和PSA分组的穿刺结果,以及每个穿刺位点的阳性率、侧区和外侧区穿刺阳性率和穿刺后并发症发生情况.结果 本组622例穿刺病理结果为,前列腺增生314例,上皮样瘤变31例,可疑前列腺癌26例,前列腺癌231例,其中前列腺癌检出率为37.1％ （231/622）.侧叶（第2、4、6、8、10、12针）总穿刺针数3 735针,阳性率21.6％（806针阳性）;左右外侧叶（第1、3、5、7、9、11针）总穿刺针数3 736针,阳性率21.3％（796针阳性）,侧区和外侧区穿刺阳性率比较差异无统计学意义（P＞0.05）.第1～12针的穿刺阳性率平均为（21.6±1.6）％,各针的阳性率比较差异无统计学意义（P＞0.05）,第1～12针各针阳性率与第X针阳性率（34.8％）比较差异有统计学意义（P＜0.05）.按年龄分组,各组阳性率分别为≤60岁组26.7％,61 ～ 70岁组32.0％,71 ～ 80岁组45.0％,＞80岁组64.0％,组间比较差异有统计学意义（P＜0.05）.按PSA水平分组分析,各组的阳性率分别为＜4 ng/ml组4.5％,4～9 ng/ml组29.2％,10 ～ 19 ng/ml组31.3％,20 ～ 39 ng/ml组15.2％,40～ 59 ng/ml组5.5％,60～79 ng/ml组2.9％,80 ～ 99 ng/ml组10.3％,≥100 ng/ml组0.8％,组间比较差异有统计学意义（P＜0.05）.Logistic回归检验结果显示,年龄（OR=1.652）、PSA值（OR=1.533）是前列腺穿刺活检阳性率的影响因素（P＜0.05）.12＋X点前列腺穿刺术后并发症包括血尿81例（13.7％）,大便带血32例（5.2％）,尿潴留26例（4.2％）,发热57例（9.2％）.结论 对于首次接受前列腺穿刺的患者,经直肠超声引导下12＋X针穿刺法在增加阳性诊断率及减少并发症发生率上都有较大的优势.不同年龄及PSA水平患者的穿刺阳性率有一定的差异,临床上可依据年龄和PSA水平在一定程度上选择是否行前列腺穿刺.

Objective To summarize the experience in transrectal ultrasound-guided 12 ＋ X-core biopsy and analyze the influencing factors of the biopsy results.Methods Totally,622 consecutive patients who had a transrectal ultrasonography （TRUS）-guided 12 ＋ X-core biopsy were retrospectively analyzed in the study from Jan.2010 to Mar.2016.The age ranged from 46 to 88 years [mean（68.1 ± 6.8） years],age ≤ 60y （116）,age 61-70y （251）,age 71-80y （230）,age 〉 80y （25）.Prostate specific antigen （PSA） ranged from 0.35 to 264ng/ml[mean （28.15 ± 31.42） ng/ml],PSA 〈4ng/ml（26）,4-9ng/ml（182）,10-19ng/ml（194）,20-39ng/ml （93）,40-59ng/ml （34）,60-79ng/ml （32）,80-99ng/ml （66）,≥ 100 ng/ml （5）.Every core positive rate,lateral zone and contralateral zone positive rate were analyzed.The biopsy positive rates were also analyzed,adjusted to the age and PSA.The complications were analyzed.The Logistic regression analysis were used for data analysis a.Results Among the 622 patients who underwent 12 ＋ X core prostate biopsy,the pathological result included BPH （314）,PIN （31）,doubtful-PCa （26） and PCa （231）.The positive biopsy rate was 37.1% （231/622）.The contralateral zone and lateral zone positive rate was 21.6% （807/3 735） and 21.3 % （796/3 736） （P 〉 0.05）,respectively.The positive rate of 1-12 core was （21.6 ± 1.6） % （P 〉 0.05） and the positive rate of X core was 34.8% （P 〈 0.05）.Subgroup analysis were conducted to evaluate the positive rate according to different factors：age ≤60y （26.7%）,age 61-70y （32%）,age 71-80y （45%）,age 〉80y （64.0%） （P 〈0.05）;Prostate specific antigen （PSA） 〈 4 ng/ml（4.5%）,4-9 ng/ml （29.2%）,10-19 ng/ml （31.3%）,20-39 ng/ml （15.2%）,40-59 ng/ml （5.5%）,60-79 ng/ml（2.9%）,80-99 ng/ml （10.3%）,≥ 100 ng/ml （0.8%） （P 〈 0.05）.The positive rate was associated with age and PSA（OR =1.652,OR =1.533,P 〈 0.05）.The postoperative complications were hematuria,bloody stool,urinary retention,fever （〉 38℃）,and the complication rate were 13.7%,5.2%,4.2%,9.2%,respectively.Conclusions The age and serum PSA were both related to the positive rate of prostate biopsy and could be used as a prediction to guide the prostate biopsy.The combination of sextant and lateral peripheral zone biopsies （12 ＋ X biopsy scheme） could have an advantage over 6 systematic biopsy and saturate biopsy scheme.