CAJ | 학술논문

目的探讨经直肠超声引导下经会阴定位模板前列腺11区穿刺活检的准确性和安全性. 方法回顾性分析2003年12月至2013年12月收治的3 007例PSA ＞4.0 μg/L和/或直肠指检异常和/或前列腺B超、CT或MRI检查异常患者的临床资料.年龄30～ 91岁,平均69岁.PSA0.2～100.0 μg/L,中位数为11.0μg/L.PSA 0 ～4.0 μg/L 176例、4.1～10.0 μg/L 1 179例、10.1～20.0 μg/L975例及20.1～100.0 μg/L 677例.所有患者均接受经直肠超声引导下经会阴定位模板前列腺11区穿刺活检.分析不同PSA下前列腺穿刺活检的阳性率和并发症,以及肿瘤病灶的空间分布. 结果本组3 007例,每例每个穿刺区活检1～4针,共11～44针,平均19针.前列腺癌活检阳性率为35.5％(1 067/3 007).PSA 0～4.0 μg/L、4.1 ～ 10.0 μg/L、10.1～20.0 μg/L及20.1 ～ 100.0 μg/L者阳性率分别为15.3％(27/176)、21.0％(248/1 179)、32.6％(318/975)及70.0％(474/677).1 067例活检阳性患者中,前列腺尖部阳性率52.0％ (555/1 067),高于其他10个区域的平均阳性率46.7％(499/1 067),差异有统计学意义(P=0.014).术后发生肉眼血尿1 413例(47.0％),血精183例(6.1％),急性尿潴留57例(1.9％),败血症1例. 结论经直肠超声引导下经会阴定位模板前列腺11区穿刺活检精确、安全.前列腺尖部的穿刺活检阳性率显著高于其他部位.
목적 탐토경직장초성인도하경회음정위모판전렬선11구천자활검적준학성화안전성. 방법 회고성분석2003년12월지2013년12월수치적3 007례PSA ＞4.0 μg/L화/혹직장지검이상화/혹전렬선B초、CT혹MRI검사이상환자적림상자료.년령30～ 91세,평균69세.PSA0.2～100.0 μg/L,중위수위11.0μg/L.PSA 0 ～4.0 μg/L 176례、4.1～10.0 μg/L 1 179례、10.1～20.0 μg/L975례급20.1～100.0 μg/L 677례.소유환자균접수경직장초성인도하경회음정위모판전렬선11구천자활검.분석불동PSA하전렬선천자활검적양성솔화병발증,이급종류병조적공간분포. 결과 본조3 007례,매례매개천자구활검1～4침,공11～44침,평균19침.전렬선암활검양성솔위35.5％(1 067/3 007).PSA 0～4.0 μg/L、4.1 ～ 10.0 μg/L、10.1～20.0 μg/L급20.1 ～ 100.0 μg/L자양성솔분별위15.3％(27/176)、21.0％(248/1 179)、32.6％(318/975)급70.0％(474/677).1 067례활검양성환자중,전렬선첨부양성솔52.0％ (555/1 067),고우기타10개구역적평균양성솔46.7％(499/1 067),차이유통계학의의(P=0.014).술후발생육안혈뇨1 413례(47.0％),혈정183례(6.1％),급성뇨저류57례(1.9％),패혈증1례. 결론 경직장초성인도하경회음정위모판전렬선11구천자활검정학、안전.전렬선첨부적천자활검양성솔현저고우기타부위.
Objective To assess the efficacy and safety of transperineal template-guided prostate biopsy.Methods From Dec,2003 to Dec 2013,a total of 3007 patients (30-91 years old,mean age 69 years old) who met the inclusion criteria underwent 11 regions transrectal ultrasound guided transperineal template prostate biopsy.The inclusion criteria included prostate-specific antigen (PSA) level more than 4.0 μg/L,abnormal prostate gland finding on digital rectal examination,ultrasound,CT or MRI.The median PSA level was 11.0 μg/L (range 0.2-100 μg/L).The patients distribution in different PSA level included 176 cases (PSA 0-4.0 μg/L),1 179 cases (PSA 4.1-10.0 μg/L),975 cases (PSA 10.1-20.0 μg/L)and 677 cases (PSA 20.1-100.0 μg/L).The prostate cancer detection rate in different PSA,prostate biopsy adverse effects,and prostate cancer spatial distribution were analyzed.Results A mean of 19 cores (ranged from 11 to 44 cores) were obtained for each biopsy.And more cores were performed in larger prostates than in smaller ones.One to four cores was implemented in each region.Prostate cancer was detected in 1 067 of 3 007 patients (35.5％).The prostate cancer detection rate in groups with PSA 0-4.0 μg/L,4.1-10.0 μg/L,10.1-20.0 μg/L,and 20.1-100.0 μg/L groups was 15.3％ (27/176),21.0％ (248/1 179),32.6％ (318/975),and 70.0％ (474/677) respectively.The mean positives rate in prostate apex was higher than in other region [46.7％ (499/1 067) vs.52.0％ (555/1 067),P=0.014].Regarding adverse effects,47.0％ (1 413/3 007) reported hematuria,6.1％ (183/3 007) developed hemospermia,1.9％ (57/3 007) needed short-term catheterization after biopsy due to acute urinary retention,one patient suffered septicemia.Conclusions Transrectal ultrasound guided transperineal template prostate biopsy is a safe and accurate technique.The current study suggests that the positive detective rate in apical region is much higher than that in other region by using this technique.