同轴针技术用于超声引导经会阴前列腺穿刺活检的疼痛控制:一项前瞻性随机对照研究

Coaxial needle technology for pain control during ultrasound-guided transperineal prostate biopsy:a prospective,randomized,controlled trial

目的探讨采用同轴针技术实施超声引导经会阴前列腺穿刺活检(transperineal prostate biopsy,TPB)的可行性、有效性和安全性,通过减少对会阴部的直接针刺次数改善TPB患者的疼痛感受。方法采用随机数表法将2019年1月至2020年12月三峡大学第一临床医学院宜昌市中心人民医院200例拟行超声引导TPB的前列腺癌患者分为同轴针组(采用同轴针定位穿刺取材,100例)和传统组(采用传统穿刺架引导下反复经会阴穿刺取材,100例),采用视觉模拟评分法(visual analog scale,VAS)评估患者穿刺术中的疼痛感受,比较两组间取材数量、穿刺取材耗时、癌症检出率、术中VAS评分和并发症的差异。结果同轴针组与传统组穿刺成功率均为100%,两组癌症检出率差异无统计学意义(48%对40%,P>0.05);同轴针组取材数量大于传统组,平均穿刺耗时小于传统组,同轴针组术中平均VAS评分低于传统组,差异有统计学意义[(14.8±1.8)条对(12.1±1.1)条,(12.9±1.3)min对(16.5±1.9)min,(2.6±1.2)分对(4.4±1.4)分;均P<0.001];同轴针组并发症发生率低于传统组,差异有统计学意义(18%对39%,P<0.01),其中同轴针组会阴部血肿及会阴部疼痛发生率低于传统组,差异有统计学意义(1%对8%,8%对19%;均P<0.05)。结论同轴针技术行超声引导下TPB,能保证取材数量和不同区域精准取材的同时,明显减少会阴部直接穿刺次数,改善前列腺癌患者穿刺过程中的疼痛,降低术后会阴部疼痛的发生率,且操作时间更短、并发症更少,值得在临床推广。

Objective To investigate the feasibility,effectiveness and safety of ultrasound-guided transperineal prostate biopsy(TPB)with coaxial needle technique,and to improve the pain perception of TPB patients by reducing the number of direct perineal needling.Methods A total of 200 patients who underwent ultrasound-guided TPB at the first clinical college of Three Gorges University&Yichang Central People′s Hospital from January 2019 to December 2020 were randomly divided into coaxial needle group(coaxial needle positioning puncture,n=100)and traditional group(traditional puncture frame guided repeated transperineal puncture,n=100).Visual analog scale(VAS)was used to evaluate the pain of patients during puncture.The number of samples,time-consuming of puncture,cancer detection rate,VAS pain score and complications between the two groups were compared.Results The success rate of puncture in the coaxial needle group and the traditional group was 100%,and there was no significant difference in the cancer detection rate between the two groups(48%vs 40%,P>0.05).The average number of samples in the coaxial needle group was larger than that in the traditional group,the average puncture time in the coaxial needle group was less than that in the traditional group,and the average intraoperative VAS score of the coaxial needle group was lower than that of the traditional group,the differences were statistically significant[(14.8±1.8)vs(12.1±1.1),(12.9±1.3)min vs(16.5±1.9)min,(2.6±1.2)vs(4.4±1.4);all P<0.001].The complication rate of the coaxial needle group was lower than that of the traditional group,the difference was statistically significant(18%vs 39%,P<0.001),the incidences of perineal hematoma and perineal pain in the coaxial needle group were lower than that in the traditional group(1%vs 8%,8%vs 19%;all P<0.05).Conclusions Coaxial needle technology for ultrasound-guided TPB can ensure the number of samples and accurate sampling in different areas,significantly reduce the number of direct perineal puncture,improve the pain in the process of puncture,reduce the incidence of postoperative perineal pain,with shorter operation time and fewer complications,which is worthy of clinical promotion.