经直肠弹性超声穿刺活检联合墨水标记法病理诊断前列腺癌的研究

The clinical research of biopsy of prostate cancer by transrectal ultrasound elastography combined ink marking

目的探讨经直肠超声前列腺穿刺活检联合墨水标记法病理诊断前列腺癌的应用价值。方法2011年10月至2014年12月，137例患者因血清前列腺特异性抗原（PsA）升高在上海市周浦医院行前列腺穿刺活检。患者随机分两组，其中普通穿刺组68例，行常规经直肠超声引导前列腺穿刺活检；弹性超声组69例，行经直肠弹性超声前列腺穿刺活检联合墨水标记法病理标本，所有标本均按前列腺两侧叶矢状面尖部、中部、底部，前列腺两外侧面中部、底部以及经直肠弹性超声异常处穿刺1～3针。所有前列腺标本在采集后，在标本末端（外周带）标记上新鲜的黑色墨水后分别分装送病理，比较两组病理结果差异及对诊疗的影响。结果普通穿刺组病理证实为前列腺癌24例，不典型增生6例，PIN3例，前列腺增生35例。弹性超声组病理证实前列腺癌31例，不典型增生7例，PIN6例，前列腺增生25例。弹性超声组前列腺癌检出率显著高于常规超声组（x^2=-3．97，P〈0．05）。两组共穿刺1543针，其中外周带穿刺阳性者42例，中央带穿刺阳性者5例，外周带及中央带均阳性者8例。Gleason评分〉7分者11例，5分≤Gleason评分≤7分者40例，Gleason评分〈5分者4例。根据穿刺前列腺所处的位置行内分泌治疗者9例，前列腺癌根治术42例，经尿道前列腺电切术4例。结论经直肠弹性超声前列腺穿刺活检联合墨水标记法有助于提高前列腺癌检出率，协助前列腺癌定位，对疾病的诊断以及手术方法的选择有着较高临床实用价值。

Objective To evaluate the utility of transrectal ultrasound elastography combined ink marking in transrectal ultrasound-guided prostate biopsies.Methods A total of 137 patients with suspected PCa were enrolled in this study. 68 patients were biopsied with routine tmnsrectal ultrasound, named routine group, the other 69 patients were biopsied with transrectal ultrasound elastography, named elastography group. Systemic 10-point puncture plus TRE exception handling puncture combined ink marking were used. All specimen-ends （peripheral zone） were marked with black ink, and the specimen placed on the foam plastic boxes. The positive rate of prostate cancer was confirmed by the location and the Gleason score. Results In routine group, biopsy confirmed prostate cancer 24 cases, 6 cases of atypical hyperplasia, PIN 3 cases, 35 cases of benign prostatic hyperplasia. In elastography group, biopsy confirmed prostate cancer 31 cases, 7 cases of atypical hyperplasia, PIN 6 cases, 25 cases of benign prostatic hyperplasia. Positive rate in elastography group was higher than that in routine group （x^2=-3.97, P=0.046）. Total number of needle puncture was 1 543, puncture-positive peripheral zone were found in 42 cases, the central 5 patients with biopsy -positive peripheral zone and central zone were positive in 8 cases. Gleason score〉7 points in 11 patients, 5≤Gleason score ≤ 7 in 40 cases, Gleason score 〈5 points in 4 patients. The line endocrine therapy was performed in 9 cases, 42 cases underwent radical prostatectomy, transurethral resection was performed in 4 cases.Conclusion Transrectal ultrasound elastography combined ink marking can improve the localization, diagnosis and treatment of prostate cancer.