徒手TRUS引导下经会阴前列腺活检的临床应用探讨

Clinical utility of freehand TRUS guided transperineal biopsy with “12+X” cores

目的:探讨徒手"12+X"法TRUS引导下经会阴前列腺活检术诊断前列腺癌的临床应用价值。方法:2014年12月~2015年12月,对74例可疑前列腺癌患者行经直肠B超引导下18G自动穿刺活检针行双侧外周带12点法系统穿刺,其中直肠指诊(DRE)触及结节24例,超声提示异常回声14例,前列腺核磁提示异常信号30例;前列腺特异性抗原(PSA)<4ng/ml者14例,PSA 4~10ng/ml 25例,PSA>10ng/ml者35例。同时对每个可疑病灶进行1~2针靶向穿刺。回顾性分析穿刺的阳性率和并发症。结果:成功对74例患者进行徒手"12+X"法TRUS引导下经会阴前列腺活检术。年龄43~81岁,中位年龄72岁;PSA 1.9~500ng/ml,中位PSA17.8ng/ml。经病理诊断,前列腺癌23例,阳性率31.1%,穿刺阴性病例中3例TURP术后病理诊断结果为前列腺癌;2例首次穿刺阴性,6个月后重复穿刺时发现前列腺癌。低危前列腺癌(Gleason≤6分)、中危前列腺癌(Gleason=7分)和高危前列腺癌(Gleason≥8分)分别为13.1%、30.4%和56.5%。其余51例为良性前列腺增生或合并前列腺炎症。术后短暂和轻度的肉眼血尿6例(8.1%),均在1~3d后缓解,5例(6.8%)轻度发热,2例(2.7%)会阴部轻度不适。无脓毒症、急性尿潴留等严重并发症的发生。结论:徒手"12+X"法TRUS引导下经会阴前列腺活检安全可行,阳性率稳定,值得在临床上进一步推广。

Objective：To evaluate the clinical value of the detection of prostate carcinoma with freehand TRUS guided transperineal biopsy with ＂12＋X＂cores in patients with elevated prostate-specific antigen.Method：From December 2014 to December 2015,a total of 74 patients with suspected prostate carcinoma were detected.Of these,24 patients had an nodule on digital rectal examination,14 patients had an abnormal echo of transabdominal or transrectal ultrasonography,30 patients had a low signal area on magnetic resonance imaging.Freehand TRUS guided transperineal biopsy was performed with ＂12＋X＂cores.We futher peformed a targeted 1-to 2-core biopsy.A retrospective analysis of the institutional registry for detection rates and complications was done.Result：Freehand TRUS guided transperineal biopsy with ＂12＋X＂cores was successfully performed in all 74 patients.The median age was 72（range,43-81）years old,and median prostate-specific antigen was 17.8（range,1.9-500）ng/ml.Transperineal biopsy identified cancer in 31.1%（23/74）patients and the rates of detection of clinically significant and insignificant cancer according to the several definitions used were 30.4% and 56.5%,respectively.Among the negative biopsies,3 had the final diagnosis of prostate carcinoma after TURP and 2 after secondary biopsy.Complications such as gross hematuria（8.1%）,fever（6.8%）and discomfort of perineal region（2.7%）were found without other serious complications.Conclusion：Freehand TRUS guided transperineal biopsy with＂12＋X＂cores appears to be an effective biopsy protocol for the detection of prostate carcinoma.