超声造影结合直肠B超在经会阴前列腺穿刺活检中的应用（附87例报告）

目的：探讨微泡造影剂结合经直肠多普勒超声（contrastenhancedtransrectualultrasound,CE-TRUS）在经会阴前列腺穿刺活检中的临床意义。方法：对87例前列腺疾病患者在CE-TRUS后行经直肠B超引导下经会阴前列腺穿刺活检,穿刺标准依据2007年新修订的《中国泌尿外科疾病诊断治疗指南》确定．先行彩色多普勒超声检查。了解并记录前列腺局灶性病变部位、大小、数目、回声特征及彩色多普勒血流等情况。结果：87倒确诊为前列腺癌和前列腺增生者分别为52例和35例,两者比较差异无统计学意义（P=0．617）。而以PSA≤20ng／ml和PSA〉20ng／ml为标准行分层分析,发现PSA≤20ng／ml者在CE-TRUS引导下经会阴前列腺穿刺阳性率高（P=0．041）。结论：CE-TRUS后经直肠B超引导下行经会阴前列腺穿刺活检是诊断前列腺癌的重要方法;PSA≤20ng／ml者结合CDTRUS行前列腺穿刺活检能提高前列腺癌穿刺阳性率。     

经直肠超声引导下经会阴前列腺穿刺315例分析

目的 探讨经直肠超声（TRUS）引导下经会阴前列腺穿刺的临床意义。方法 对315例PSA〉4ng／ml、直肠指检异常或B超发现异常回声的患者行经会阴的6点系统加异常回声处活检。年龄43～91岁，平均72岁。PSA〈4ng／ml者66例，4～10ng／ml者96例，10～20ng／ml者90例，〉20ng／ml者63例。结果 穿刺活检证实为前列腺癌111例，阳性率35．2％。PSA〉4ng／ml、指检异常、B超发现异常回声及PSAD〉0．15者穿刺阳性率分别为43．4％（108／249）、42．9％（75／175）、32．8％（63／192）及52．1％（75／144）。以PSAD〉0．15时的阳性率为最高，与其余3种标准相比差异有统计学意义。结论 TRUS引导下经会阴前列腺穿刺准确率高，并发症少而轻，是诊断前列腺癌的重要方法。     

超声造影在直肠超声前列腺穿刺活检中的应用价值

目的：探讨超声造影（CEUS）下直肠超声前列腺穿刺活检诊断前列腺癌的价值。方法：对70例高危前列腺癌患者行前列腺穿刺活检,其中普通直肠超声（TRUS）组穿刺活检34例,CEUS组36例。结果：CEUS组36例患者共接受穿刺282针,平均7．8针;TRUS组34例接受穿刺279针,平均8．2针。CEUS组发现前列腺癌9例,阳性率为25．0％;TRUS组8例,阳性率为23．5％,两组阳性率比较,差异无统计学意义。而穿刺组织条石蜡病理标本显示,CEUS组282针中,阳性针数37针,阳性率为13．1％;TRUS组279针中,阳性针数25针,阳性率为8．9％;两者阳性率比较,差异有统计学意义（P〈0．05）。两组患者穿刺后无严重并发症发生。结论：CEUS下直肠超声引导前列腺穿刺活检安全可靠,可以提高诊断前列腺癌的敏感性。     

经直肠超声引导前列腺穿刺活检203例临床分析

目的评估经直肠超声引导的前列腺六针穿刺活检在前列腺癌及前列腺其他疾病的诊断和鉴别诊断的价值。方法对指肛检查阳性，血清PSA〉4pg／L及经直肠超声检查前列腺声像图异常怀疑有占位性病变的203人进行经直肠超声引导的前列腺穿刺活检。结果穿刺活检的203例病理结果：良性前列腺增生（BPH）104例占51．24％，前列腺癌（PCa）95例占46．80％，前列腺结核及前列腺平滑肌肉瘤各2例，分别占0．98％。结论经直肠超声引导的前列腺穿刺活检其操作简单，病人痛苦小，并发症少，较安全。在前列腺癌及其他前列腺疾病的诊断与鉴别诊断中有重要的临床价值。     

超声造影检查在经会阴前列腺穿刺活检中的应用价值

目的 探讨超声造影检查在经直肠超声引导下(CE-TRUS)经会阴前列腺穿刺活检中的临床应用价值.方法 病例选择标准:①直肠指检异常;②PSA>10 ng/ml;③PSA 4～10 ng/ml,f/t PSA异常或PSAD值异常,符合以上之一者即入围此研究.共116例入选者,年龄50～84岁,既往均无前列腺手术病史.行6点系统加异常回声处活检,其中PSA＜10ng/ml者25例,10 ng/ml～者25例,20 ng/ml～者11例,>30 ng/ml者55例.行CF-TRUS经会阴前列腺穿刺活检,彩色多普勒超声检查并记录前列腺局灶性病变部位、回声特征及彩色多普勒血流等情况,其中43例行前列腺超声造影,了解并记录异常血流部位.结果 116例患者穿刺活检证实前列腺癌64例,BPH 52例.43例行超声造影检查后活检者,前列腺癌和BPH分别为25及18例,造影组和非造影组前列腺癌穿刺阳性率比较差异无统计学意义(P=0.622).PSA≤30ng/ml组共61例,其中行超声造影23例,发现前列腺癌8例,未造影组38例中发现前列腺癌5例,造影组穿刺阳性率高于非造影组,2组比较差异有统计学意义(P=0.046);PSA>30 ng/ml患者造影和非造影穿刺阳性率(97.1%与85.0%)比较差异无统计学意义(P=0.095). 结论与B超引导下经直肠前列腺活检相比,CE-TRUS经会阴前列腺穿刺活检并发症少而轻.PSA≤30ng/ml患者结合超声造影检查能提高前列腺癌穿刺阳性率.     

经直肠超声引导下前列腺穿刺活检在前列腺癌诊断中的价值（附238例报告）

目的：分析经直肠超声引导下前列腺穿刺活检在前列腺癌诊断中的应用价值。方法对疑似前列腺癌的238例患者施行经直肠超声引导下行前列腺穿刺活检。结果经穿刺后病理检查证实为前列腺癌88例（37．0％）,前列腺增生105例（44．1％）,低级别前列腺上皮内瘤15例,非典型增生17例（7．1％）,腺瘤样变8例（3．4％）,肉芽肿性前列腺炎5例（2．1％）。结论经直肠超声引导下前列腺穿刺活检具有准确、安全等优点,是诊断前列腺癌的有效方法。     

经直肠超声引导下前列腺穿刺活检540例临床分析

目的评价经直肠超声引导下前列腺穿刺活检诊断前列腺癌（PCa）的临床应用价值,提高PCa的诊治水平。方法回顾性分析血PSA升高和（或）直肠指检前列腺结节及超声检查有异常的540例患者经直肠超声引导下前列腺穿刺活检的临床资料和声像图表现。其中直肠指诊异常者248例;超声显示有异常回声结节者178例,145例为低回声,占81.4％,42例在声像图上未发现异常;380例PSA〉10μg／L。结果540例活检中PCa220例,阳性率为40．7％,前列腺肉瘤4例,前列腺增生症269例,前列腺增生症并上皮内瘤（PIN）35例,前列腺炎9例,前列腺结核2例,非典型增生1例。结论经直肠超声引导下前列腺穿刺活检是诊断PCa的一种安全有效的检查方法。     

超声引导下经直肠前列腺饱和穿刺在首次活检阴性人群中的诊断价值

目的探讨超声引导下经直肠饱和穿刺在临床疑诊为前列腺癌但首次活检阴性患者中的诊断价值,评价其有效性和安全性。方法将120例因前列腺特异抗原（PSA）和（或）直肠指检异常而接受前列腺12针穿刺活检、且结果为阴性的患者纳入研究,随机分为扩大穿刺组（采用12针扩大穿刺法）和饱和穿刺组（采用24针饱和穿刺法）,行超声引导下经直肠重复穿刺活检。对两组患者均行前列腺周围神经阻滞术,穿刺活检过程中观察患者情况,并采用视觉模拟评分（VAS）评估疼痛程度。结果两组患者年龄、总PSA水平、PSA密度、前列腺总体积及移行区体积、首次穿刺病理、直肠指诊情况、穿刺活检过程中患者VAS和术后并发症差异均无统计学意义（P均＞O．05）。饱和穿刺组前列腺体积＞60ml者的穿刺阳性率高于扩大穿刺组（P-0．033）,其穿刺总体阳性率亦高于扩大穿刺组（31．67％VS15．00％,P-0．031）。结论经直肠饱和穿刺活检可以提高临床疑诊前列腺癌但首次活检阴性者的前列腺癌检出率,且不增加并发症发生率。     

超声引导下经直肠系统性12＋1针前列腺穿刺活检术

目的探讨超声引导下经直肠系统性12＋1针前列腺穿刺活检术诊断前列腺癌的临床价值。方法回顾性分析816例经直肠前列腺系统性12＋1针穿刺活检的可疑前列腺癌患者。其中PSA＜4ng／ml、直肠指诊发现结节者66例;PSA介于4～10ng／ml、f／tPSA值异常、PSAD值异常者190例;PSA〉10ng／ml、任何f／tPSA、PSAD值者560例。结果816例患者中活检病理确诊为前列腺癌者358例,总阳性率为43．9％（358／816）。其中位于前列腺尖部阳性者235例,占确诊病例总数的65．6％（235／358）。术后发热9例（1．0％,9／816）,并发血尿49例（6．0％,49／816）。几乎所有患者皆有短时大便带血。无其他严重并发症发生。结论超声引导下经直肠系统性前列腺12＋1针穿刺活检术定位准确,创伤较小,并发症较少。可以随机增加穿刺点,利于提高前列腺癌检出率。     

经直肠超声引导下前列腺穿刺活检术的临床意义

目的探讨经直肠超声引导下前列腺穿刺活检术的临床意义。方法对60例PSA〉4ng／ml、直肠指检异常或超声发现异常回声的患者采用前列腺穿刺活检术，其中30例患者采用骶管内麻醉下经直肠超声引导前列腺穿刺活检术，年龄45～86岁，平均68±3．6岁，PSA〈4ng／ml为4例，4-10ng／ml为10例，〉10ng／ml为16例。对照组30例，年龄50-84岁，平均70±3．5岁，PSA〈4ng/ml为3例，4-10ng／ml为9例，〉10ng／ml为18例。对照组采用直肠指检压迫下穿刺或表面麻醉下行经直肠超声引导下穿刺活检。结果骶管内麻醉组阳性率为60％（18／30），患者术中无疼痛表现，对照组阳性率为33％（10/30），患者在术中伴有不同程度的疼痛。结论与常规穿刺相比，骶麻下经直肠超声引导下前列腺穿刺活检术准确性高，疼痛较轻，更能被患者接受，值得临床推广使用。     

Transperineal prostatic biopsy guided by ultrasound

Thirty-three cases with clinical symptoms and signs suspecting prostatic cancer or other prostatic entities with abnormal ultrasonic reflection were diagnosed by transperineal prostatic biopsy guided by intrarectal ultrasonic probing. This procedure more accurate and safer than the conventional one. It seems quite useful clinically in the differential diagnosis of prostatic carcinoma, particularly the early cases from the other prostatic diseases.     

经会阴前列腺穿刺484例分析

目的 分析484例直肠超声导引下经会阴前列腺穿刺病例,以提高穿刺活检的阳性率.方法 484例患者,以PSA＞4 ng/ml或肛指检查异常或B超发现异常回声为穿刺指征,行经会阴的6～8点系列加异常回声处活检.患者采取膀胱截石位,充分暴露会阴部.以1%利多卡因10 ml作浸润麻醉,至前列腺包膜.随后用自动活检枪以6针系列穿刺法对前列腺双侧外周带各2针,移行带各1针.对B超发现的可疑处另穿刺数针.其中315例使用Alokal700彩超仪和Promag2.2活检枪,另169例用ESAOTE TechrosMPS彩超仪和BardMagmun活检枪.结果 两组共484例,前列腺癌173例（35.7%）,前列腺增生262例（54.1%）,各级PIN35例（7.2%）,不典型增生12例（2.8%）,慢性肉芽肿性炎2例（0.4%）.Aloka组和ESAOTE组之间的阳性率比较无统计学上显著性差异.结论 经会阴前列腺穿刺活检是一种并发症较轻,阳性率较高的前列腺肿瘤的诊断方法,且在不同B超仪和活检枪情况下可以达到相似的阳性率.     

血清PSA值和前列腺结节指导前列腺穿刺活检的临床意义

目的 探讨血清ＰＳＡ浓度变化与前列腺癌及其骨转移的相关性。方法 对９３例直肠指诊异常及血清ＰＳＡ〉４ｎｇ／ｍｌ的患者,行直脾性Ｂ超引志下前列腺穿刺活检;用９９ｍＴｃ－ＭＤＰ行全身骨扫描判断有无骨。结果 ９３例中前列腺活检阳性者６０例,其中２６例扫描阳性;随血清ＰＳＡ浓度升高,前列腺阳性活检率及其远处骨转移阳性率升高。 血清ＰＳＡ升高与前列腺癌及其骨转移的发生率呈正相关。     

Intraepithelial prostatic neoplasia

44 patients seeked medical advice for low urinary symptoms. Their examination consisted of digital rectal investigation, test for prostate-specific antigen (PSA) in the serum, transurethral ultrasonic investigation, fine needle multifocal biopsy of the prostate. Three groups were identified by the PSA levels. 7 patients of group 1 had PSA up to 6 ng/ml. Cancer was diagnosed in 3 of them, prostatic intraepithelial neoplasia (PIN) in 4 patients. 16 patients of group 2 had PSA within 7-10 ng/ml. In this group only 1 patient had cancer, the rest 15 had PIN. 21 patients of group 3 with PSA at least 10 ng/ml had cancer, benign prostatic hyperplasia, PIN (12, 2 and 7 patients, respectively). 3 patients with high-grade PIN and PSA above 10 ng/ml in 6 months were diagnosed to have adenocarcinoma, in 6 such patients signs of dysplasia disappeared after antiandrogenic therapy. Further investigations on diagnosis and treatment of PIN are desirable.     

超声引导下经会阴定位模板的前列腺饱和穿刺活检

目的探讨超声引导下经会阴定位模板前列腺饱和穿刺活检的准确性、安全性。方法303例PSA〉4．0ng／ml和（或）DRE异常和（或）前列腺B超、CT或MRI异常者接受经会阴定位模板饱和穿刺活检。年龄35～90岁，平均69．7岁。PSA0．2～3000．0ng／ml，中位数13．7ng／ml。前列腺体积7～190ml，中位数47ml。结果每区活检1～4针，共11～44针，平均23．7针。前列腺癌活检阳性率37．6％（114／303）。PSA0～4．0、4．1～10．0、10．1～20．0、20．1～30．0、30．1～70．0及〉70．0ng／ml者阳性率分别为22．2％（4／18）、8．2％（6／73）、21．6％（22／102）、48．4％（15／31）、68．4％（26／38）及100．0％（41／41）。前列腺体积〈20、20～40、41～60及〉60ml者阳性率分别为68．0％（17／25）、51．4％（54／105）、27．5％（19／69）及23．1％（24／104）。无一例出现严重并发症。结论TRUS引导下经会阴定位模板饱和穿刺活检精确而安全，对于前列腺癌的准确分期有重要意义。     

经直肠超声引导下“10+X”点法前列腺穿刺活检术在PSA值介于4～20ng/ml之间患者前列腺癌诊断中的价值

目的 探讨经直肠超声引导下“10 +X”前列腺穿刺活检术在PSA值介于4 ～20ng/ml之间患者前列腺癌诊断中的价值。方法 回顾性分析226例血清PSA值介于4～20ng/ml之间疑似前列腺癌患者临床资料,所有患者均行经直肠超声引导下前列腺穿刺术活检。结果 前列腺癌47例,前列腺增生158例,前列腺炎11例,前列腺上...     

骶麻下经直肠超声引导前列腺穿刺活检术

目的:探讨骶麻下经直肠超声引导行前列腺穿刺活检术的应用价值。方法:我院为60例前列腺特异抗原(pros-tate specific antigen,PSA)>4ng/ml、直肠指检异常或B超示异常回声的患者采用前列腺穿刺活检术。其中研究组30例采用骶管内麻醉经直肠超声引导行前列腺穿刺活检术,45～86岁,平均68岁,PSA<4ng/ml4例,4～10ng/ml10例,>10ng/ml16例;对照组30例采用直肠指检压迫下穿刺或表麻下行经直肠B超引导下穿刺活检,50～84岁,平均70岁,PSA<4ng/ml3例,4～10ng/ml9例,>10ng/ml18例。结果:研究组18例检出阳性,阳性率60%,患者术中无痛;对照组10例检出阳性,阳性率33%,术中患者均有不同程度的疼痛。结论:采用骶麻下经直肠超声引导行前列腺穿刺活检术准确性高,无疼痛表现,更易被患者接受,值得临床推广应用。     

Treatment of chronic prostatitis lowers serum prostate specific antigen

PURPOSE: We evaluated men with documented chronic prostatitis and elevated serum prostate specific antigen (PSA) to determine whether treatment with antibiotics and anti-inflammatory drugs lowers serum PSA. MATERIALS AND METHODS: We retrospectively reviewed the records of 95 men who presented with serum PSA greater than 4 ng./ml. and were subsequently diagnosed with chronic prostatitis with greater than 10 white blood cells per high power field in expressed prostatic excretions. Patients meeting these criteria were treated with a 4-week course of antibiotics and a nonsteroidal anti-inflammatory agent. In all patients followup PSA was determined within 2 months of treatment. RESULTS: Mean PSA decreased 36.4% from 8.48 ng./ml. before to 5.39 after treatment (p <0.001). In 44 patients (46.3%) serum PSA decreased to below 4 ng./ml. (mean 2.48) and these patients no longer had an indication for biopsy. In the remaining 51 patients serum PSA remained elevated at greater than 4 ng./ml. and they underwent double sextant transrectal ultrasound guided biopsy. Pathological study showed prostate cancer in 13 cases (25.5%), chronic inflammation in 37 (72.5%) and only benign prostatic hypertrophy in 1 (1.05%). PSA in the 13 patients with prostate cancer decreased with treatment only 4.8% from 8.32 to 7.92 ng./ml. (p >0.05). Followup PSA at a mean of 11.4 months was determined in 19 of the 44 men who responded to treatment. Mean PSA increased only 4.5% from 2.35 to 2.46 ng./ml. (p >0.05) during this followup interval. CONCLUSIONS: In almost half of the patients diagnosed with elevated PSA and chronic prostatitis serum PSA normalized with treatment and there was no longer an indication for transrectal ultrasound guided biopsy. Our study suggests that chronic prostatitis is an important cause of elevated PSA and when it is identified, treatment can decrease the percent of negative biopsies.     

Effect of inflammation and benign prostatic enlargement on total and percent free serum prostatic specific antigen

OBJECTIVE: To analyze the influence of inflammation and benign prostatic enlargement on total and percent free serum prostatic specific antigen (PSA). PATIENTS AND METHODS: Total and free PSA serum levels were determined in 284 patients with no evidence of cancer in the sextant ultrasound-guided biopsy. Double antibody immunoradiometric assay Tandem and Tandem free PSA were used. Benign tissue without inflammation was found in 23.2% of the patients (group 1), while in 68.3%, it was associated with chronic prostatitis (group 2) and with acute prostatitis in 8.4% (group 3). RESULTS: Median serum PSA was 7.8 ng/ml in group 1, 6.7 ng/ml in group 2 and 6.4 ng/ml in group 3, p>0.05. Median percent free PSA was 14.1, 15.6 and 16.4%, respectively, p>0.05. Multiple linear regression analysis showed that prostatic size was the only significant contributor to serum PSA concentration. Moreover, total PSA and prostatic size contributed significantly to the percent free serum PSA. Inflammation had no significant influence on total or percent free serum PSA. CONCLUSION: Inflammation has an important prevalence in cancer-free prostatic biopsy specimens. It seems to have no significant influence on total and percent free serum PSA. However, prostatic size seems to be the major contributor.