超声造影引导下经直肠穿刺活检在前列腺癌中的诊断价值

The diagnostic value of ultrasound contrast guided transrectal biopsy in prostate cancer

目的 探讨超声造影引导下经直肠穿刺活检在前列腺癌中的诊断价值.方法 选取我院收治的前列腺疾病患者198例为研究对象.将研究对象按照不同检查方法分为两组,采用超声造影引导穿刺活检设为造影组96例,采用多普勒超声引导穿刺活检设为超声组102例.将穿刺结果与病理学诊断进行对照.对比两种穿刺方法的前列腺癌阳性率和穿刺针数,评价超声造影引导经直肠前列腺穿刺活检在前列腺癌诊断中的应用价值.结果 198例患者全部接受病理学诊断,78例为良性病变,120例确诊为前列腺癌.经病理活检证实造影组有良性病变36例,前列腺癌60例;超声组有良性病变42例,前列腺癌60例.造影组前列腺癌穿刺阳性率为62.5％(60/96),超声组为58.82％ (60/102),两组患者前列腺癌阳性率比较差异无统计学意义(x2=0.104,P=0.747).造影组前列腺癌的阳性穿刺点数为28.50％(17/60),高于超声组的18.80％(11/60),差异有统计学意义(P=0.001).造影组每例患者平均穿刺8.19针,比超声组人均穿刺11.31针少.在血清游离前列腺特异性抗原(fPSA)与总前列腺特异性抗原(tPSA)比值(f/tPSA)≤0.15时,造影组前列腺癌穿刺阳性率46.55％(27/58)高于超声组9.30％(4/43),差异有统计学意义(P=0.001);f/tPSA＞0.15时,造影组的前列腺癌穿刺阳性率92.11％(35/38)低于超声组94.92％(56/59),但差异无统计学意义(P=0.89).造影组出现肛区疼痛、肉眼血尿和血便的患者明显少于超声组7.29％ (7/96)与22.55％ (23/102)、2.08％ (2/96)与8.82％ (9/102)、10.42％(10/96)与23.53％ (24/102)],差异均有统计学意义(P=0.003、P=0.039、P=0.014).结论 超声造影引导下经直肠穿刺活检对前列腺癌具有重要的诊断价值,在降低穿刺针数的前提下,有效提高了前列腺癌检出的阳性率,减轻了患者的痛苦,减少了穿刺后并发症的发生.f/tPSA≤0.15时,造影组前列腺癌穿刺阳性率高于超声组,穿刺效果更好.

Objective To investigate the clinical value of clinical application in diagnosis of prostate cancer (PCa) by prostate biopsy guided by rectal ultrasound contrast guided biopsy.Methods One hundred and ninety-eight patients with prostate in Punan Hospital of Pudong New District of Shanghai were investigated.According to different detection methods, the research objects were divided into two groups, the patients were performed with the ultrasound contrast guided biopsy as the imaging group (n =96), the patients with Doppler ultrasound guided biopsy as the ultrasonic group(n =102).The puncture Results were compared with pathological diagnosis.The positive rate of PCa and number of puncture needle were compared with the two puncture methods.The value of the application of the prostate biopsy guided by rectal ultrasound in diagnosis of prostate cancer was evaluated.Result One hundred and ninety-eight patients were all received pathological diagnosis,78 cases benign lesions, 120 cases were diagnosed as PCa.Thirty-six cases of benign lesions were confirmed by pathological biopsy, 60 case PCa.There were 42 cases of benign lesions in ultrasonic group, 60 case PCa.The positive rate of PCa in the imaging groupwas 62.5％ (60/96), the ultrasonic group was 58.82％ (60/102).There was no difference in Pca positive rate between the ultrasound group and the contrast group(x2 =0.104, P=0.747).The positive number of Pca in the imaging group was 28.50％ (17/60), the difference was statistically significant higher than that of the common group(18.80％ (11/60), P =0.001).The average of the patients in the imaging group was 8.19 needle,less than the ultrasonic group per capita 11.31 needle less.When f/tPSA less than or equal to 0.15, Pca positive rate of the contrast group was 46.55％ (27/55), higher than the ultrasonic group(9.30％ (4/43)), the difference was statistically significant (P =0.001);when f/tPSA more than 0.15, the positive rate of Pca in the contrast group was 92.11％ (35/38), less than the ultrasound group (94.92 (56/59)), the difference was not statistically significant (P =0.89).Anal pain, hematuria and hematochezia in contrast group (7.29％ (7/96), 2.08％ (2/96), 10.42％ (10/96)) were significantly less than the ultrasound group(22.55％ (23/102), 8.82％ (9/102), 23.53％ (24/102)), the difference was statistically significant (P =0.003,0.039,0.014).Conclusion Under the guidance of ultrasound contrast, rectal biopsy has important diagnostic value for prostate cancer.Under the premise of reducing the number of puncture needle,can improvethe positive rate of Pca, reduce the pain of patients and the occurrence of complications after puncture.When f/tPSAless than or equal to 0.15,puncture positive rate in contrast group is higher than the ultrasonic group, puncture effect is better.