超声引导经直肠前列腺穿刺活检术(附192例报告)

目的评价经直肠超声(TRUS)结合彩色多谱勒血流图象(CDI)对前列腺穿刺活检的指导作用.方法依据TRUS结合CDI选择穿刺点,采用个体化方案对192例PSA＞4ng/m1、可疑前列腺癌(PCA)的患者,行经直肠前列腺穿刺活检,对其中12例PSA持续升高者行重复穿刺.结果 (1)PSA4～10ng/m170例,PCa9例(12.9%)、其中7例CDI有异常血流;阴性61例、其中9例CDI有异常血流.(2)PSA11～150ng/m1122例,PCa47例(38.5%)、其中37例CDI有异常血流;阴性75例、其中14例CDI有异常血流.CDI在PCa与穿刺阴性间比较有极显著性差异(P＜0.001),重复穿刺者12例中发现PCA5例.结论依据TRUS结合CDI采用个体化方案的前列腺穿刺活检术,能提高PCa检出率和减少并发症.     

经直肠超声引导前列腺穿刺活检术诊断前列腺癌

目的　总结和评价经直肠超声引导下前列腺穿刺活检术对前列腺癌诊断的准确率。方法　222 例直肠指检阳性或 PSA>4μg/L的患者应用经直肠超声引导下前列腺6点系统穿刺活检以明确诊断。结果　222 例受检者中病理证实前列腺结节性增生41例、前列腺炎24例、前列腺肉瘤3例、前列腺癌 154 例,其中低分化癌 74 例、中分化癌 58 例、高分化癌 22 例。术后血尿15例、发热6例,其中高热1例,经抗生素治疗后体温恢复正常、尿检阴性。结论　经直肠超声引导下前列腺穿刺活检无需麻醉,患者痛苦小、安全性高,是诊断前列腺癌的可靠方法。     

超声引导下经直肠前列腺穿刺活检

原则上只在怀疑前列腺癌或已确诊前列腺癌计划进行诊治时行前列腺活检。指征:①前列腺指诊怀疑癌肿。②PSA值升高:德国泌尿外科学会认为PSA值直接诊断的不是前列腺癌,而是进行活检的指征,阈值≥4ng/ml为活检指征(UrolA ,2 0 0 2 ,4 1:5 0 9)。此外,fPAS/tPSA值<2 8%和30 % ,以及PSA值1年升高0 .75ng/ml者建议穿刺活检。方法:①部位:6分仪法即在旁矢状面前列腺尖部、中部和基底部,双侧中央取标本活检,其阳性率高于指诊可疑区域的活检,但仍有2 0 %假阴性。改良方法为自前列腺侧叶外1/ 3取6个标本活检(外周区)。②数目:增加活检数目可提…     

超声引导下经会阴穿刺活检在前列腺癌诊断中的价值

目的：探讨超声引导下经会阴道前列腺穿刺活检诊断前列腺癌的价值。方法：对376例临床怀疑前列腺癌患者行直肠腔内超声引导下经会阴前列腺穿刺活检。分3组。A组：184例,为指检前列腺触及结节或前列腺增大、质硬怀疑前列腺癌者;B组：84例,为因前列腺增生行直肠腔内超声检查发现有异常回声区域者;C组：108例,为指检未及明显硬节而血中PSA＞10ng/ml者。结果：3组穿刺活检阳性率分别为44．5％（82／184）,29．8％（25／84）,57．4％（62／108）。结论：直肠腔内超声引导下经会阴穿刺活检取材准确,能清楚显示穿刺针的径路和深度,避免损伤邻近脏器,可重复操作,明显提高穿刺活检的阳性率。     

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。     

经直肠超声引导前列腺系统穿刺活检术的并发症

1998年 8月～ 2 0 0 0年 6月 ,对 137例拟诊前列腺癌患者行经直肠超声引导13点前列腺系统穿刺活检术 ,对术后并发症及治疗情况进行分析 ,报告如下。资料和方法　本组 137例。年龄5 1～ 86岁 ,平均 70岁。活检指征 :直肠指诊阳性和 (或 )ＰＳＡ >4ｎｇ/ｍｌ。本组直肠指诊阳性者 5 6例 (4 1% )。ＰＳＡ <4ｎｇ/ｍｌ者 12例 (9% ) ,>10ｎｇ/ｍｌ者 82例 (6 0 % ) ,4～ 10ｎｇ/ｍｌ者 43例 (31% )。门诊患者 31例 ,采用电话随访。术前常规清洁肠道。手术前后 2～3ｄ常规口服氟喹诺酮类抗生素。术后观察出血、感染、疼痛及血管迷走神经反应等情…     

经直肠超声引导前列腺穿刺活检方案的合理选择

经直肠超声(TRUS)引导前列腺穿刺活检是前列腺癌诊断和制定合理治疗方案的常规手段。制定扩大前列腺系统性穿刺方案时需综合考虑患者的年龄、前列腺体积及健康状况等因素。在系统性穿刺活检的基础上结合靶向性穿刺活检可提高前列腺癌的阳性率。     

直肠根治术后经会阴超声引导下经会阴前列腺穿刺活检确诊前列腺癌1例

<正>1 病例资料患者,83岁,2021年7月13日因外院体检发现前列腺特异抗原(prostate specific antigen, PSA)异常升高1月无法行多参数磁共振检查入院。患者外院查tPSA:9.32 ng/mL,无明显下尿路症状,无肉眼血尿。既往于2006年因直肠癌行经腹会阴联合直肠根治术,肛门已闭,造瘘口位于左下腹。入院查体：会阴部皮肤毛发正常,无异常红肿及破溃。实验室检查：PSA 10.10 ng/mL,     

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。     

经直肠超声定位前列腺穿刺术后感染并发症的临床分析

目的:研究经直肠超声定位前列腺穿刺术(TRUSPB)术后感染并发症的特点、危险因素及其预防措施。方法:回顾性分析我院2010年1月~2013年6月行TRUSPB术的571例患者术后并发感染35例的临床资料并文献复习。结果:前列腺体积(45ml)可作为TRUSPB术后感染的独立的预测因素,而年龄、前列腺特异抗原(PSA)与感染并发症无明显统计学关联。结论:穿刺术前应评估危险因素,对于前列腺体积较大患者要告知感染风险,并积极预防对症处理,TRUSPB仍是临床首选的安全性较好的诊断前列腺癌的方法之一。     

经直肠与经会阴途径穿刺活检诊断前列腺癌的对比分析

目的比较经直肠途径与经会阴途径穿刺活检对前列腺癌(PCa)的检出率。方法回顾性收集128例首次确诊的PCa患者,根据活检途径不同,分为经直肠途径组62例和经会阴途径组66例,比较2种途径诊断不同总前列腺特异性抗原(TPSA)水平PCa及临床意义前列腺癌(CsPCa)检出率的差异。对其中104例(经直肠途径组42例,经会阴途径组62例)在常规超声检查基础上行CEUS,于83例(经直肠途径组28例,经会阴途径组55例)检出阳性病灶后行靶向穿刺,比较2组系统穿刺及靶向穿刺PCa、CsPCa的检出率。结果经直肠途径组PCa检出率为35.48%(22/62),CsPCa检出率为25.81%(16/62);经会阴途径组PCa检出率为42.42%(28/66),CsPCa检出率为28.79%(19/66),差异均无统计学意义(P=0.471、0.676);2组对不同TPSA水平PCa及CsPCa的检出率差异均无统计学意义(P均0.05)。经直肠途径组与经会阴途径组在系统穿刺中PCa检出率[35.48%(22/62) vs 40.91%(27/66);P=0.587]、阳性针数/总针数[14.25%(106/744) vs 14.52%(115/792);P=0.879]、CsPCa检出率[25.81%(16/62) vs 28.79%(19/66);P=0.676]差异均无统计学意义;靶向穿刺活检PCa检出率[35.71%(10/28) vs 14.55%(8/55);P=0.002]、阳性针数/总针数[30.77%(24/78) vs 6.76%(10/148);P0.001]差异有统计学意义。结论超声引导下前列腺穿刺活检经直肠途径与经会阴途径对PCa及CsPCa检出率无差异。CEUS可引导前列腺靶向穿刺活检,穿刺操作时选择与CEUS相同的患者体位及解剖断面可提高PCa检出率。     

Impact of transrectal ultrasound guided prostate biopsy on quality of life: a prospective randomized trial comparing 6 versus 12 cores

PURPOSE: Recent studies advocating an increase in the number of cores of sextant transrectal ultrasound guided biopsy of the prostate to improve the cancer detection rate often have not addressed the impact on quality of life. We performed a prospective randomized trial comparing 6 to 12 prostate biopsy cores to determine the impact on the cancer detection rate, pain and morbidity, and quality of life. We report the impact on health related and screening specific quality of life in men undergoing 6 versus 12 core transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: We prospectively randomized 244 men with a mean age plus or minus standard deviation of 65 +/- 8 years, serum total prostate specific antigen between 2.5 and 20.0 ng./ml., and/or digital rectal examination findings suspicious of cancer to undergo 6 or 12 core peripheral zone tissue biopsy. Of the men 71 (29%) were black. All patients completed a self-administered questionnaire before, and 2 questionnaires 2 and 4 weeks after the procedure. Health related quality of life was measured using 2 subscales (emotional well-being and role limitation due to physical health) of the short form 36-Item Health Survey. Screening specific quality of life was addressed by questions on the functional consequences of the procedure (return to daily activity, work-employment and sports-exercise). Health related and screening specific quality of life responses were compared in the groups. RESULTS: After controlling for cancer diagnosis, patient age, race, education, report of pain and baseline emotional well-being there was no significant difference in the mean change in emotional well-being scores at 2 and 4 weeks in the 6 and 12 core groups (p = 0.7 and 0.3, respectively). Similarly after controlling for these factors and baseline role limitation due to physical health there was no significant difference in the mean change in role limitation due to physical health scores at 2 and 4 weeks in the 2 groups (p = 0.3 and 0.5, respectively). There was no difference in the percent of men returning to routine daily activity (p = 0.6), work-employment (p = 0.5) or sports-exercise (p = 0.3) at 0 to 1, 2 to 3 and 4 to 7 days or longer than 1 week after the procedure in the groups. CONCLUSIONS: Doubling the sextant biopsy does not affect the quality of life in regard to emotional well-being, role limitation due to physical health, or return to routine daily activity, work-employment or sports-exercise.     

经会阴及经直肠前列腺穿刺活检术的临床应用分析

目的:比较经直肠及经会阴两种前列腺穿刺活检术的阳性率及并发症。方法:回顾性分析2009年1月至2014年1月间156例前列腺穿刺活检病例,其中经直肠径路97例,经会阴径路59例。结果:经直肠径路组穿刺阳性率为48.4%,经会阴径路组为44.1%。根据不同的PSA水平分层,两种径路穿刺活检的阳性率无显著性差异(P0.05)。穿刺后经直肠径路组与经会阴径路组血尿发生率分别为54.6%、42.4%,尿频尿急尿痛发生率分别为17.5%、22.0%,排尿困难发生率分别为9.3%、6.8%,急性尿潴留发生率分别为7.2%、6.8%,上述并发症发生率在两组间差异无统计学意义(P0.05);发热发生率分别为15.5%、3.4%,血便发生率分别为50.5%、3.4%,经直肠径路组要显著高于经会阴径路组(P0.05及P0.01);会阴肿胀发生率分别为3.1%、13.6%,经会阴径路组显著性增高(P0.05)。结论:超声引导下经直肠和经会阴前列腺穿刺活检术都是诊断前列腺癌的有效方法。两种方式的穿刺阳性率无显著性差异,但并发症发生率各有特点,具体方式选择应根据患者情况决定。     

Accuracy of transrectal ultrasound guided prostate biopsy: Histopathological correlation to matched prostatectomy specimens

BACKGROUND: The Gleason grading system is currently the world's most commonly used histological system for prostate cancer. It provides significant information about the prognosis. Therefore, Gleason score is accepted as an important factor in therapeutic decision-making for prostate cancer. This retrospective study assessed the correlation of transrectal ultrasound (TRUS) guided biopsy and radical prostatectomy specimens in terms of Gleason scores. METHODS: We reviewed the records of 103 patients who underwent radical prostatectomy due to clinically localized prostate cancer. The Gleason scores of the TRUS biopsies were compared with the respective Gleason scores of surgical specimen. RESULTS: In 28.7% of cases, the TRUS biopsy score was the same as that of the radical prostatectomy specimen. The most significant discordance was the upgrading of well-differentiated tumors after surgery in 71.7% of cases. However, in 81.8% of cases with high Gleason score on TRUS, biopsy was correlated with poorly differentiated tumor after surgery. CONCLUSIONS: Well-differentiated tumors on TRUS biopsy did not correlate with the grades of final pathology in the majority of cases; however, a high Gleason score on TRUS biopsy usually indicated a poorly differentiated tumor on prostatectomy specimen. Therefore, the treatment algorithms for particularly well-differentiated tumors should not be deduced from biopsy histology alone.     

How to decrease pain during transrectal ultrasound guided prostate biopsy: a look at the literature

PURPOSE: There is growing interest among urologists on the need for decreasing pain during transrectal ultrasound (TRUS) guided prostate biopsy. MATERIALS AND METHODS: We performed a systematic MEDLINE search of clinical trials of any kind of anesthesia, analgesia or sedation during TRUS guided prostate biopsy published since 2000. We critically analyzed the impact of pain and discomfort associated with the procedure, the described methods for evaluating it and the different techniques that have been described. RESULTS: There is strong evidence in the current literature that patient tolerance and comfort during TRUS guided prostate biopsy can be improved by anesthesia/analgesia. What remains is the need to urge all urologists to introduce it in clinical practice as a routine part of the procedure, whatever the biopsy scheme. CONCLUSIONS: Of the various options periprostatic anesthetic infiltration has been shown to be safe, easy to perform and highly effective. It should be considered the gold standard at the moment, even if the optimal technique remains to be established. Further studies addressing this issue are warranted.