TRUS及超声造影联合MRI引导前列腺靶向穿刺的临床研究

Clinical study of targeted prostate puncture guided by TRUS and contrast-enhanced ultrasound combined with MRI

目的探讨经直肠超声(transrectal ultrasound,TRUS)及超声造影联合MRI引导前列腺靶向穿刺的临床应用价值。方法对行前列腺穿刺活组织检查并经手术病理证实的187例患者进行回顾性分析,其中前列腺10点系统穿刺患者102例,靶向穿刺患者85例,比较2组穿刺前列腺癌检出率、穿刺针数及Gleason评分情况。结果靶向穿刺组穿刺阳性率和术后病理符合率高于系统穿刺组,差异有统计学意义(P<0.05);2组术后病理前列腺癌检出率差异无统计学意义(P>0.05)。85例靶向穿刺患者中高危组穿刺286针,危险组158针,可疑组105针,补针组63针,高危组穿刺阳性率高于可疑组和补针组,差异有统计学意义(P<0.05)。靶向穿刺组术后Gleason评分的高分符合率高于系统穿刺组,差异有统计学意义(P<0.05);2组穿刺结果和术后病理结果的Gleason评分差异无统计学意义(P>0.05)。结论 TRUS及超声造影联合MRI引导前列腺靶向穿刺能明显提高前列腺癌检出率,且减少了穿刺针数,能提高较高Gleason评分前列腺癌的检出率,有较高的临床应用价值。

Objective To evaluate the clinical value of targeted prostate puncture guided by transrectal ultrasound（TRUS） and contrast-enhanced ultrasound combined with MRI. Methods A retrospectrte analysis was performed in 187 patients＇who underwent prostate biopsy and confirmed by surgical pathology. One hundred and two patients had the transrectal ultrasoundguided systematic biopsy, and 85 patients had the targeted biopsy. The prostate cancer detection rate, needle number and Gleason score were compared between the 2 groups. Results The positive rate and the coincidence rate of postoperative pathology of the target group were higher than that of the systematic group. The difference was statistically significant（P〈0.05）, There was no significant difference in the detection rate of postoperative pathologic prostate cancer between the two groups（P〉0. 05）. Among the 85 cases of target puncture, 286-pin in the highrisk group, 158-pin in the dangerous group, 105-pin in the suspicious group., and 63-pin in the complement group. The positive rate of high-risk was higher than the suspicious group and the additional puncturing group, the difference was statistically significant （P〈0.05）. The coincidence rate of high score of the Gleason score in the target group was higher than that in the systematic group, the difference was statistically significant（P〈0.05）. There was no statistically significant difference in Gleason score of postoperative pathologic findings between two groups （P〉 0.05）. Conclusion TRUS and contrast-enhanced ultrasound combined with MRI compartmental localization can significantly improve the positive rate of prostate cancer, reduce the number of puncture needles, and improve the detection rate of high Gleason score of prostate cancer, which have a higher clinical value.