16G和18G穿刺针在超声引导下经直肠前列腺活检对前列腺癌的诊断效果及并发症比较

16-gauge vs 18-gauge puncture needle for transrectal ultrasound-guided prostate biopsy in the diagnosis of prostate cancer:Effect and complications

目的:增加穿刺针的直径可能通过获取更多组织而提高前列腺癌的检出率。本研究旨在比较16G和18G穿刺针在超声引导下经直肠前列腺活检诊断前列腺癌的效果及并发症。方法:本研究为前瞻性随机对照研究。2015年7月至2018年7月在超声引导下经直肠前列腺活检的142例患者作为研究对象,采用随机数表法将142例患者分为16G组和18G组,每组各71例。穿刺后比较两组血尿、出血和感染事件的发生率。采用Clavien-Dindo评分对并发症进行分级。结果:18G组前列腺癌检出率明显低于16G组(12.68%vs 36.62%),差异有统计学意义(χ^2=10.958,P=0.001)。当f/tPSA≤0.15时,18G组前列腺癌检出率仍明显低于16G组(8.51%vs 44.44%),差异有统计学意义(χ^2=12.617,P=0.001)。当f/tPSA>0.15时,两组间PCa穿刺检出率的差异无统计学意义(P<0.05)。两组活检后直肠出血(21.13%vs 15.49%)和尿道出血(18.31%vs 16.90%)的发生率比较无统计学差异(χ^2=0.753,P=0.385;χ^2=0.049,P=0.826),两组均未见感染并发症的发生。根据Clavien-Dindo分级:18G组Ⅰ级26例,16G组20例;两组均无Ⅱ级;18G组Ⅲa级2例,16G组3例,两组Clavien-Dindo分级的比较无统计学差异(Z=-0.698,P=0.458)。结论:活检针16G前列腺癌的检出率比18G高,且不增加并发症的发生率。

Objective:To compare the efficiency and complications of transrectal ultrasound(TRUS)-guided prostate biopsy with a 16-gauge(16G)or an 18G puncture needle in the diagnosis of PCa.Methods:This prospective randomized controlled study included 142 male patients undergoing TRUS-guided prostate biopsy in our hospital,71 with the 16G and the other 71 with the 18G puncture needle.We compared the post-puncture incidence rates of hematuria,bleeding and infection between the two groups of patients and classified the complications according to the Clavien-Dindo scores.Results:The detection rate of PCa was significantly lower in the 18G than in the 16G group(12.68%vs 36.62%,χ^2=10.958,P=0.001),even with f/tPSA≤0.15(8.51%vs 44.44%,χ^2=12.617,P=0.001),but showed no statistically significant difference between the two groups with f/tPSA>0.15(P<0.05).No post-puncture infection was observed in any of the patients.There were no statistically significant differences between the 18G and 16G groups in the incidence rates of rectal bleeding(21.13%vs 15.49%,χ^2=0.753,P=0.385)and urethral bleeding(18.31%vs 16.90%,χ^2=0.049,P=0.826),nor in Clavien-Dindo grades(26 vs 20 cases of grade I;no grade II in either group;2 vs 3 cases of grade III;Z=-0.698,P=0.458).Conclusion:The 16G puncture needle can achieve a higher detection rate of PCa than the 18G needle in TRUS-guided prostate biopsy without increasing the incidence of complications.