医药前沿
醫藥前沿
의약전연
YIAYAO QIANYAN
2014年
13期
37-39
,共3页
王尧%黄品同%刘春媚%张旭
王堯%黃品同%劉春媚%張旭
왕요%황품동%류춘미%장욱
超声检查%造影剂%活组织检查%前列腺肿瘤
超聲檢查%造影劑%活組織檢查%前列腺腫瘤
초성검사%조영제%활조직검사%전렬선종류
Ultrasonography%Contrast agent%Biopsy%Prostate neoplasms
目的：探讨经直肠超声造影技术在前列腺癌的诊断及靶向引导前列腺癌的穿刺活检中的临床应用价值。方法：对81例血清前列腺特异抗原(PSA)升高(≥4.00ng/ml)的患者进行经直肠前列腺穿刺。活检前所有患者均接受常规经直肠超声(TRUS)检查和经直肠超声造影（CE-TRUS）检查，检查完成后即刻在TRUS引导下，对每位患者前列腺双侧底部、中部的内侧、外侧区和双侧前列腺尖部，行10点系统穿刺以及CE-TRUS发现的异常区域的靶向穿刺，以病理结果为金标准，比较两种技术检出前列腺癌的敏感性和穿刺点阳性率，以及CE-TRUS对诊断不同血清PSA值的前列腺癌患者的临床价值。结果：81例患者共穿刺910针，经穿刺病理诊断为前列腺癌的为35例（43.2%）142针（15.6%）。CE-TRUS发现异常者37例，其中前列腺癌患者27例，其诊断敏感性、特异性、准确性分别为77.1%、78.2%、77.8%，显著高于TRUS的62.8%、67.3%、65.4%（P<0.05）；CE-TRUS靶向穿刺点的单针阳性率（30.0%）高于系统穿刺的（13.8%（）P<0.05）：在35例前列腺癌患者中，CE-TRUS靶向穿刺检出病人的阳性率（77.1%）则低于系统穿刺（85.7%）（P<0.05）。另外，CE-TRUS技术在血清PSA<10ng/ml患者中的诊断阳性率(24.3%)与血清PSA≥10ng/ml的患者（40.9%）之间没有显著差异（P>0.05）。结论：CE-TRUS较TRUS能检出更多的前列腺癌病例数，其引导的靶向穿刺较系统穿刺具有更好的单针阳性率,但由于在病人检出率上的差异，靶向穿刺仍无法取代系统穿刺。
目的：探討經直腸超聲造影技術在前列腺癌的診斷及靶嚮引導前列腺癌的穿刺活檢中的臨床應用價值。方法：對81例血清前列腺特異抗原(PSA)升高(≥4.00ng/ml)的患者進行經直腸前列腺穿刺。活檢前所有患者均接受常規經直腸超聲(TRUS)檢查和經直腸超聲造影（CE-TRUS）檢查，檢查完成後即刻在TRUS引導下，對每位患者前列腺雙側底部、中部的內側、外側區和雙側前列腺尖部，行10點繫統穿刺以及CE-TRUS髮現的異常區域的靶嚮穿刺，以病理結果為金標準，比較兩種技術檢齣前列腺癌的敏感性和穿刺點暘性率，以及CE-TRUS對診斷不同血清PSA值的前列腺癌患者的臨床價值。結果：81例患者共穿刺910針，經穿刺病理診斷為前列腺癌的為35例（43.2%）142針（15.6%）。CE-TRUS髮現異常者37例，其中前列腺癌患者27例，其診斷敏感性、特異性、準確性分彆為77.1%、78.2%、77.8%，顯著高于TRUS的62.8%、67.3%、65.4%（P<0.05）；CE-TRUS靶嚮穿刺點的單針暘性率（30.0%）高于繫統穿刺的（13.8%（）P<0.05）：在35例前列腺癌患者中，CE-TRUS靶嚮穿刺檢齣病人的暘性率（77.1%）則低于繫統穿刺（85.7%）（P<0.05）。另外，CE-TRUS技術在血清PSA<10ng/ml患者中的診斷暘性率(24.3%)與血清PSA≥10ng/ml的患者（40.9%）之間沒有顯著差異（P>0.05）。結論：CE-TRUS較TRUS能檢齣更多的前列腺癌病例數，其引導的靶嚮穿刺較繫統穿刺具有更好的單針暘性率,但由于在病人檢齣率上的差異，靶嚮穿刺仍無法取代繫統穿刺。
목적：탐토경직장초성조영기술재전렬선암적진단급파향인도전렬선암적천자활검중적림상응용개치。방법：대81례혈청전렬선특이항원(PSA)승고(≥4.00ng/ml)적환자진행경직장전렬선천자。활검전소유환자균접수상규경직장초성(TRUS)검사화경직장초성조영（CE-TRUS）검사，검사완성후즉각재TRUS인도하，대매위환자전렬선쌍측저부、중부적내측、외측구화쌍측전렬선첨부，행10점계통천자이급CE-TRUS발현적이상구역적파향천자，이병리결과위금표준，비교량충기술검출전렬선암적민감성화천자점양성솔，이급CE-TRUS대진단불동혈청PSA치적전렬선암환자적림상개치。결과：81례환자공천자910침，경천자병리진단위전렬선암적위35례（43.2%）142침（15.6%）。CE-TRUS발현이상자37례，기중전렬선암환자27례，기진단민감성、특이성、준학성분별위77.1%、78.2%、77.8%，현저고우TRUS적62.8%、67.3%、65.4%（P<0.05）；CE-TRUS파향천자점적단침양성솔（30.0%）고우계통천자적（13.8%（）P<0.05）：재35례전렬선암환자중，CE-TRUS파향천자검출병인적양성솔（77.1%）칙저우계통천자（85.7%）（P<0.05）。령외，CE-TRUS기술재혈청PSA<10ng/ml환자중적진단양성솔(24.3%)여혈청PSA≥10ng/ml적환자（40.9%）지간몰유현저차이（P>0.05）。결론：CE-TRUS교TRUS능검출경다적전렬선암병례수，기인도적파향천자교계통천자구유경호적단침양성솔,단유우재병인검출솔상적차이，파향천자잉무법취대계통천자。
Objective: To evaluate the value of contrast-enhanced transrectal ultrasonography(CE-TRUS)in detecting prostate cancer. Methods: Eighty-one patients with elevated serum prostate-specific antigen (PSA) levels (more than 4.00ng/mL)were evaluated with transrectal ultrasonography(TRUS) and contrast-enhanced transrectal ultrasonography(CE-TRUS) , a 10-core systematic biopsy(SB) was subsequently performed at the base,the mid gland and the apex in each patient and the targeted biopsy (TB)was performed at abnormal CE-TRUS areas. Diagnostic efficiency of the two techniques for the cancer detection was compared and the targeted biopsy was also compared to systematic biopsy. Results: Prostate cancer was detected in 142(15.6%)of 910 specimens in 35(43.2%)of 81 patients.CE-TRUS could detect 27 patients diagnosed with cancer in 37 patients in whom CE-TRUS showed abnormal., CE-TRUS had higher sensitivity specificity and overal accuracy(77.1%, 78.2%and77.8%)than TRUS (62.8%,67.3%and 65.4%)(p<0.05,p<0.05,p<0.05); positive biopsies were more frequently obtained in 30 of 100 (30.0%)targeted cores compared to 112 of 810 (13.8%) systematic cores ,while on a per patient basis ,the prostate cancer was more frequently detected by SB(30)compared to TB(27) (P < 0.05) in those 35 patients with prostate cancer. The diagnostic efficiency of CE-TRUS technology in PSA<10ng/ml patients (24.3%) compared to that in the PSA ≥ 10ng/ml patients (40.9%)had no significant difference (P>0.05). Conclusion :CE-TRUS may detect more cases of prostate cancer than TRUS and targeted biopsy of contrast-enhanced abnormalities provides a significant benefit for the detection of prostate cancer, but systematic biopsies should not be eliminated on the basis of many cancers missed by CE-TRUS .
