CAJ | 학술논문

目的探讨直肠超声引导下经会阴精囊腺穿刺活检术在评价前列腺癌临床分期中的可行性和安全性.方法回顾性分析2010年7月至2015年1月收治的57例伴有精囊异常的疑似前列腺癌患者的临床资料.年龄50 ～ 78岁,平均(65±7)岁.血清总前列腺特异性抗原(tPSA)3.2 ～ 131.1 μg/L,平均(23.7±11.3) μg/L.22例直肠指检可触及前列腺结节.结合MRI检查结果,临床分期均为T3b期.局麻下,57例均行超声及模板引导下经会阴前列腺及精囊腺分区穿刺活检,前列腺分为11区,每区穿刺1～4针;两侧精囊腺分别自外侧向中央穿刺3针,尽量靠近膀胱底部.穿刺组织送病理检查.结果 57例均顺利完成穿刺.穿刺病理检查发现前列腺癌44例,Gleason评分6～10分.其中累及精囊腺32例(阳性组),肿瘤分期T3b期;未累及12例(阴性组),肿瘤分期T2期.阳性组中20例行根治性前列腺切除术,术后病理诊断均提示前列腺癌累及精囊腺,术后病理分期为T3b期.阴性组中11例行根治性前列腺切除术,2例术后病理诊断提示累及精囊腺,肿瘤分期为T3b期.精囊腺穿刺敏感性为91％ (20/22),特异性为100％ (9/9),阳性预测值为100％(20/20),阴性预测值为82％ (9/11).57例穿刺后均无发热,发生肉眼血尿23例(40％)、血精20例(35％)、尿潴留1例(2％),对症处理后症状消失.结论直肠超声引导下经会阴精囊腺穿刺安全、可靠,有助于提高前列腺癌术前临床分期的准确率.
목적 탐토직장초성인도하경회음정낭선천자활검술재평개전렬선암림상분기중적가행성화안전성.방법 회고성분석2010년7월지2015년1월수치적57례반유정낭이상적의사전렬선암환자적림상자료.년령50 ～ 78세,평균(65±7)세.혈청총전렬선특이성항원(tPSA)3.2 ～ 131.1 μg/L,평균(23.7±11.3) μg/L.22례직장지검가촉급전렬선결절.결합MRI검사결과,림상분기균위T3b기.국마하,57례균행초성급모판인도하경회음전렬선급정낭선분구천자활검,전렬선분위11구,매구천자1～4침;량측정낭선분별자외측향중앙천자3침,진량고근방광저부.천자조직송병리검사.결과 57례균순리완성천자.천자병리검사발현전렬선암44례,Gleason평분6～10분.기중루급정낭선32례(양성조),종류분기T3b기;미루급12례(음성조),종류분기T2기.양성조중20례행근치성전렬선절제술,술후병리진단균제시전렬선암루급정낭선,술후병리분기위T3b기.음성조중11례행근치성전렬선절제술,2례술후병리진단제시루급정낭선,종류분기위T3b기.정낭선천자민감성위91％ (20/22),특이성위100％ (9/9),양성예측치위100％(20/20),음성예측치위82％ (9/11).57례천자후균무발열,발생육안혈뇨23례(40％)、혈정20례(35％)、뇨저류1례(2％),대증처리후증상소실.결론 직장초성인도하경회음정낭선천자안전、가고,유조우제고전렬선암술전림상분기적준학솔.
Objective To explore the safty and feasibility of transrectal ultrasound guided transperineal seminal vesicle biopsy in the evaluation of clinical staging of prostate cancer.Methods Retrospectively study 57 suspected prostate cancer patients with seminal abnormality during 2010.7-2015.1,age ranged from 50 to 78 years,average 65 ±7 years,serum total prostate specific antigen (tPSA) 3.2-131.1 μg/L, average (23.7 ± 11.3) μg/L.Twenty-two cases had palpable prostate nodules through rectal examination.All the 57 patients underwent ultrasound and template guided transperineal prostate and seminal vesicle puncture biopsies.Results Forty-four cases out of 57 found prostate cancer cells in biopsies, and 32 cases had seminal vesicle invasion (positive group) while the other 12 were negative.Twenty cases had been performed prostatectomy in the positive group and their post-operative pathological examination all showed prostate cancer with seminal vesicle invasion.Eleven cases in the negative group had been performed prostatectomy ,and 2 cases showed seminal vesicle invasion.The clinical stages of all cases in the positive group were considered as T3b both pre-operatively and post-operatively.In the negative group however, 11 cases were considered as T2 stage pre-operatively,while 2 cases were increased to T3b stage post-operatively.The sensitivity of puncturing seminal vesicle was 91％ (20/22) ,specificity was 100.0％ (9/9).Positive predictive value was 100.0％ (20/20),while negative predictive value was 82％ (9/11).All the 57 cases did not present fever after puncture biopsies, while 23 cases presented hematuria (40％) ,20 cases presented hemospermia (35％) and 1 case presented urinary retention (2％).Conclusions Transrectal ultrasound-guided transperinealseminal vesicle puncture is safe and reliable, it helps to improve the accuracy of pre-operative staging.