微创泌尿外科杂志
微創泌尿外科雜誌
미창비뇨외과잡지
JOURNAL OF MINIMALLY INVASIVE UROLOGY
2014年
5期
263-267
,共5页
郭刚%许勇%王岩%丛冰%张旭
郭剛%許勇%王巖%叢冰%張旭
곽강%허용%왕암%총빙%장욱
前列腺癌%穿刺活检%经会阴%前列腺特异性抗原
前列腺癌%穿刺活檢%經會陰%前列腺特異性抗原
전렬선암%천자활검%경회음%전렬선특이성항원
prostate carcinoma%biopsy%transperineal%prostate specific antigen
目的：：评价直肠超声引导下经会阴模版12＋X针前列腺穿刺活检术的临床价值和安全性.方法：2009年9月~2014年5月,对临床怀疑为前列腺癌的1300例患者行直肠超声引导下经会阴模板前列腺穿刺活检术.1300例患者平均年龄70.5岁,穿刺前均行血清PSA监测(不少于2次)、前列腺直肠指诊、经直肠前列腺超声及前列腺磁共振平扫加动态增强.所有患者取截石位,1％利多卡因注射液10~20 ml会阴皮下及前列腺尖部局部浸润麻醉973例,骶管阻滞麻醉75例,硬膜外麻醉252例.共937例采用12＋X针穿刺,363例采用常规12针穿刺.结果：所有患者均顺利完成操作,活检针数12~24针,平均14.5针；活检时间15~30 min,平均20.4 min.术后发生一过性血尿201例,会阴部血肿14例,尿潴留21例,发热5例.穿刺病理结果：前列腺癌540例(41.5％),其中腺癌527例,其他类型肿瘤13例；前列腺上皮内瘤(PIN)57例(4.4％)；前列腺增生及各类前列腺炎703例(54.1％).T-PSA＜4μg/L、4~＜10μg/L、10~20μg/L及＞20μg/L组的穿刺阳性率分别为：13.1％、17.1％、31.9％、73.8％.T-PSA 4~＜10μg/L组(灰区)293例患者分别以 F/T PSA 和 PSAD 分组, F/T≥0.16和＜0.16组的穿刺阳性率分别为12.0％、18.8％,PSAD≥0.15和＜0.15组的穿刺阳性率分别为9.8％、21.5％.直肠指诊异常、经直肠超声异常及前列腺 MRI 异常患者的穿刺阳性率分别为：24.0％、30.1％、59.2％.12＋X针组穿刺阳性率为47.2％,12针组为34.5％.结论：直肠超声引导下经会阴12＋X 针前列腺穿刺活检术阳性率高,并发症少,是诊断前列腺癌的理想方法.
目的：：評價直腸超聲引導下經會陰模版12＋X針前列腺穿刺活檢術的臨床價值和安全性.方法：2009年9月~2014年5月,對臨床懷疑為前列腺癌的1300例患者行直腸超聲引導下經會陰模闆前列腺穿刺活檢術.1300例患者平均年齡70.5歲,穿刺前均行血清PSA鑑測(不少于2次)、前列腺直腸指診、經直腸前列腺超聲及前列腺磁共振平掃加動態增彊.所有患者取截石位,1％利多卡因註射液10~20 ml會陰皮下及前列腺尖部跼部浸潤痳醉973例,骶管阻滯痳醉75例,硬膜外痳醉252例.共937例採用12＋X針穿刺,363例採用常規12針穿刺.結果：所有患者均順利完成操作,活檢針數12~24針,平均14.5針；活檢時間15~30 min,平均20.4 min.術後髮生一過性血尿201例,會陰部血腫14例,尿潴留21例,髮熱5例.穿刺病理結果：前列腺癌540例(41.5％),其中腺癌527例,其他類型腫瘤13例；前列腺上皮內瘤(PIN)57例(4.4％)；前列腺增生及各類前列腺炎703例(54.1％).T-PSA＜4μg/L、4~＜10μg/L、10~20μg/L及＞20μg/L組的穿刺暘性率分彆為：13.1％、17.1％、31.9％、73.8％.T-PSA 4~＜10μg/L組(灰區)293例患者分彆以 F/T PSA 和 PSAD 分組, F/T≥0.16和＜0.16組的穿刺暘性率分彆為12.0％、18.8％,PSAD≥0.15和＜0.15組的穿刺暘性率分彆為9.8％、21.5％.直腸指診異常、經直腸超聲異常及前列腺 MRI 異常患者的穿刺暘性率分彆為：24.0％、30.1％、59.2％.12＋X針組穿刺暘性率為47.2％,12針組為34.5％.結論：直腸超聲引導下經會陰12＋X 針前列腺穿刺活檢術暘性率高,併髮癥少,是診斷前列腺癌的理想方法.
목적：：평개직장초성인도하경회음모판12＋X침전렬선천자활검술적림상개치화안전성.방법：2009년9월~2014년5월,대림상부의위전렬선암적1300례환자행직장초성인도하경회음모판전렬선천자활검술.1300례환자평균년령70.5세,천자전균행혈청PSA감측(불소우2차)、전렬선직장지진、경직장전렬선초성급전렬선자공진평소가동태증강.소유환자취절석위,1％리다잡인주사액10~20 ml회음피하급전렬선첨부국부침윤마취973례,저관조체마취75례,경막외마취252례.공937례채용12＋X침천자,363례채용상규12침천자.결과：소유환자균순리완성조작,활검침수12~24침,평균14.5침；활검시간15~30 min,평균20.4 min.술후발생일과성혈뇨201례,회음부혈종14례,뇨저류21례,발열5례.천자병리결과：전렬선암540례(41.5％),기중선암527례,기타류형종류13례；전렬선상피내류(PIN)57례(4.4％)；전렬선증생급각류전렬선염703례(54.1％).T-PSA＜4μg/L、4~＜10μg/L、10~20μg/L급＞20μg/L조적천자양성솔분별위：13.1％、17.1％、31.9％、73.8％.T-PSA 4~＜10μg/L조(회구)293례환자분별이 F/T PSA 화 PSAD 분조, F/T≥0.16화＜0.16조적천자양성솔분별위12.0％、18.8％,PSAD≥0.15화＜0.15조적천자양성솔분별위9.8％、21.5％.직장지진이상、경직장초성이상급전렬선 MRI 이상환자적천자양성솔분별위：24.0％、30.1％、59.2％.12＋X침조천자양성솔위47.2％,12침조위34.5％.결론：직장초성인도하경회음12＋X 침전렬선천자활검술양성솔고,병발증소,시진단전렬선암적이상방법.
Objective:To explore the clinical value and safety of TRUS-guided transperineal biopsy with the 12+X method in the diagnosis of prostate carcinoma.Methods:A total of 1300 men underwent TRUS-guided transperi-neal biopsy with the 12+X method for suspected prostate carcinoma from Sep.2009 to May 2014.The average age was 70.5 years old.All patients received PSA level,digital rectal examination(DRE),TRUS and MRI examinations. 937 cases received 12+X-core method biopsy and 363 cases received 12-core biopsy.Their clinical data were retro-spectively analyzed.Results:The average number of biopsy core was 14.5(range 12 to 24).The average operation time was 20.4 min(15 to 30 min).Prostate carcinoma was detected in 540 (41.5%),accounting for 13.1%, 17.1%,31.9% and 73.8% in those with PSA <4.0μg/L,4-<10μg/L,10-20μg/L and >20μg/L respectively, 24.0% in those with abnormal findings DRE,30.1% in those with abnormal echoes on TRUS and 59.2% in those with abnormal echoes on MRI.Complications after prostatic biopsy included gross hematuria in 201 cases,acute uri-nary retention in 21 and fever in 5,but no other serious complications were observed.The positive rate was 47.2%in 12+X-core group and 34.5% in 12-core group.Conclusions:TRUS-gu ided transpefineal biopsy with the 12+X method,with high accuracy and fewer complications,is an ideal approach to the diagnosis of prostate carcinoma.
