经直肠常规超声在前列腺实性结节良恶性鉴别诊断中的价值

目的探讨经直肠常规超声在前列腺结节定性诊断中的应用价值。方法对临床怀疑前列腺疾病患者行经直肠二维超声、彩色多普勒超声及能量多普勒超声检查,检出前列腺实性结节患者43例共55个结节,分析良恶性结节超声图像特征,并将结果与病理结果对照。结果55个实性结节病理证实33个恶性（恶性组）、22个良性（良性组）。恶性组与良性组比较,良恶性结节在发生部位上差异有统计学意义（P〈0．05）;而良恶性结节声像图在形态、边界、内部回声及血流分级上差异均无统计学意义（P〉0．05）。经直肠超声诊断前列腺癌的灵敏度、特异度、诊断准确度分别为60．6％、54．5％、58．2％。结论经直肠常规超声图像清晰,对前列腺结节分辨力高,在发现结节和定位诊断方面具有重要的临床应用价值,但前列腺良恶性结节声像图存在交叉重叠,经直肠超声对前列腺结节良恶性的鉴别价值有限。     

经直肠超声在妇科疾病中的诊断价值

目的：探讨经直肠彩色多普勒超声在妇科疾病中的应用价值。方法：将经直肠和经腹检查的53例患者检查结果与临床诊断结果进行对比。结果：经腹部超声诊断符合率为60．38％,经直肠超声诊断符合率为92．45％。结论：经直肠超声诊断符合率高于经腹超声,在不适合做经阴道超声的情况下,经直肠超声值得推广使用。     

Prospective trial comparing transrectal ultrasonography and transurethral seminal vesiculoscopy for persistent hematospermia

Objective: To compare the diagnostic yield of transrectal ultrasonography and transurethral seminal vesiculoscopy in patients with persistent hematospermia, and to determine the advantages and disadvantages of both modalities. Methods: We prospectively enrolled 106 patients with persistent hematospermia of mean duration 20.5 months. All patients were evaluated by both transrectal ultrasonography and transurethral seminal vesiculoscopy after excluding definite etiological lesions beyond the reproductive duct system. The diagnostic yield and other technical parameters of both modalities were compared. Results: Final diagnoses were made in 93 patients (87.7%), with transrectal ultrasonography and transurethral seminal vesiculoscopy showing overall diagnostic yields of 45.3% and 74.5%, respectively (P < 0.001). The diagnostic yield of combining transrectal ultrasonography and transurethral seminal vesiculoscopy was significantly higher than that of each modality alone (both P < 0.001). Of the 114 findings of diagnostic value, the most frequent was calculus (47.4%, n = 54), followed by obstruction/stricture (37.7%, n = 43), cyst (8.8%, n = 10), dysplasia (3.5%, n = 4), polyp (1.8%, n = 2) and benign mass (0.9%, n = 1). Transurethral seminal vesiculoscopy showed significant superiority in detecting calculi and obstruction/stricture. Hematospermia disappeared in 95.3% (101/106) of all patients and in 97.6% (83/85) of patients receiving transurethral seminal vesiculoscopy therapy during follow up. No major adverse effects occurred during and after examination. Conclusions: The diagnostic yield of transurethral seminal vesiculoscopy for persistent hematospermia was significantly superior to that of transrectal ultrasonography, especially in lesions diagnosed with calculi and obstruction/stricture. Combining both modalities might provide extra benefits for patients with persistent hematospermia.     

Role of Doppler ultrasound and resistive index in benign prostatic hypertrophy

BACKGROUND: The aim of the present study was to assess the resistive index in patients with benign prostatic hypertrophy (BPH) and the role of power Doppler ultrasonography. METHODS: From April 1996 to December 1997, a total of 214 men aged 48-86 years with symptoms of BPH were prospectively enrolled to participate in our study. All patients presented to our clinic with lower urinary tract symptoms. Transrectal ultrasonography was used to calculate the total prostate volume (TPV), transition zone (TZ) volume, transition zone index (TZI = TZ volume/TPV) and presumed circle area ratio (PCAR). Power Doppler imaging was used to identify the capsular and urethral arteries of the prostate and measure its resistive index (RI) value. RESULTS: The RI of capsular arteries significantly correlated with theTPV, TZ volume, TZI (r = 0.470; P < 0.0001) and PCAR (r = 0.334; P < 0.0001). Correlations were found between the RI of capsular arteries and the International Prostatic Symptom Score (IPSS) (r = 0.389; P < 0.0001), peak flow rate of uroflowmetry (r = -0.393; P < 0.0001). CONCLUSION: We demonstrated that an increase of the RI of capsular arteries correlated with increases in the TZI and PCAR in BPH. The lower IPSS and peak flow rate correlated with the high RI of capsular arteries; however, no correlation between the RI of urethral arteries and prostatic parameters was found. The findings suggested that the RI of capsular arteries may become the index for measuring lower urinary obstruction in the future.     

经直肠超声引导穿刺活检诊断早期前列腺癌漏诊原因的分析

目的:分析经直肠超声(TRUS)引导下穿刺活检诊断前列腺癌的漏诊原因,减少漏诊率,提高诊断率。方法:80例疑似前列腺癌的良性前列腺增生(BPH)患者行TRUS引导下穿刺活检,结果均为阴性,均行前列腺电切术(TURP),术后标本行病理检查。结果:25例术后病理报告为前列腺癌,漏诊率31.25%(25/80)。其中10例行经会阴前列腺癌根治术、8例行手术去势、7例行药物去势。结论:TRUS引导穿刺活检诊断前列腺癌存在一定的漏诊,多次或多点穿刺活检可以减少漏诊率。     

Transrectal ultrasound-guided biopsy of the prostate: What you see is not what you get

A prospective trial involving 282 patients, beginning in December 1993, was undertaken to assess the correlation between our sonographic impression of prostatic malignancy and the histological findings of a random six quadrant biopsy in addition to histology of any sonographically evident focal peripheral zone (PZ) abnormality. The sonographic criteria used to suggest malignancy were: (i) presence of hypo-echoic PZ nodule; (ii) inhomogeneity of PZ; and (iii) loss of zonal architecture (ZA). The sonographic appearance was graded as either definitely benign, indeterminate, or definitely malignant. These impressions were then compared with the histology results. Eighty-two patients had histologically proven malignancy. Ultrasound showed the correct extent and site of malignancy in 42 patients. A further 26 patients had the extent of their malignancy either over- or under-estimated or had the malignancy placed in an incorrect site. Fourteen patients with histologically proven carcinoma had sonographically normal PZs. These findings highlight the shortcomings of ultrasound as a diagnostic tool in prostate cancer and show that six quadrant random biopsy of the prostate is far superior to unifocal biopsy of sonographically evident masses in the detection of prostate cancer.     

骶麻下经直肠超声引导前列腺穿刺活检的临床护理

目的:探讨骶麻下经直肠超声引导前列腺穿刺活检的临床护理方法。方法:选取我院实施骶麻下经直肠超声引导前列腺穿刺活检术病例共60例,术前对患者进行耐心的心理护理以及健康教育,术后密切监测生命体征,加强消化道以及泌尿道护理。结果:60例患者于穿刺过程中均无疼痛,术后并发症轻微,活检阳性率40%。结论:做好临床护理有利于提高诊断准确率,减少并发症。     

Optimization of prostate cancer diagnosis by increasing the number of core biopsies based on gland volume

In this prospective, non-randomized phase-I clinical trial, we comparatively studied the performance of six laterally-directed biopsies or the modified fan-shaped biopsies (MFSB), midline sextant biopsies (MB), and transition zone biopsies (TZB) and examine their prostate cancer (PCa) detection rates. A total of 114 patients received combinations of MFSB, MB, and TZB based on prostate gland volume: those ≤15cc received 8 biopsies; those >15cc but ≤ 50cc received 14 biopsies; and those >50cc received 20 biopsies. The mean prostate-specific antigen (PSA) level, Gleason score, and prostate volume were 8.0 ng/ml, 6.4, and 47 cc, respectively. PCa detection rate of the MB was 25% while the MFSB was 22%. The overall PCa detection rate was 33.3% with all biopsies. PCa and high-grade prostatic intraepithelial neoplasia (HG-PIN) detection rates decrease as the size of the prostate increases. PCa detection rates were 50.0% for volumes ≤19.9cc and volumes of >50cc had a detection rate of 25.8%. PSA levels of <3.0 had PCa detection rates of 15% which increased to 58% with PSA levels >9.0. In a multivariate analysis, only TZB was significant for PCa diagnosed by PSA (β=7.4, p<0.01). Our study showed that it is important to perform both the lateral MFSB and the MB to improve overall PCa detections rates. Thus, we recommend performing MB, MFSB, and TZB based on prostate volume, as follows: 8 biopsies for ≤15 cc; 14 for those >15 cc but ≤50 cc, and 14-20 for those >50 cc.     

经腹联合经直肠或(阴道)彩色多普勒超声检查对原发性膀胱癌的诊断价值

目的 探讨经腹联合经直肠或阴道彩色多普勒超声对原发性膀胱癌的诊断价值.方法 对临床疑为原发性膀胱癌的病例,分别进行经腹、经直肠(或经阴道)以及两者联合的彩色多普勒超声检查,比较三者的诊断率.结果 32例患者中,经腹部超声诊断膀胱癌25例,诊断率为78％;经直肠(或阴道)超声诊断膀胱癌29例,诊断率为90％;经腹联合经直...     

直肠指检和经直肠超声检查对血清前列腺特异抗原≤4ng／ml的前列腺癌的诊断价值

目的探讨直肠指检（digitalrectalexamination,DRE）和经直肠超声检查（transrectalultrasonography,TRUS）对血清前列腺特异抗原（prostatespecificantigen,PSA）≤4ng／ml的前列腺癌的诊断价值。方法对112例血清PSA≤4ng／ml而DRE或（和）TRUS异常的男性患者进行了TRUS引导的前列腺系统10针＋可疑区穿刺活检。根据血清PSA范围将病例分成0～0．9ng／ml,1．0～1．9ng／ml,2．0—2．9ng／ml和3．0～4．0ng／ml4组。结果112例病例中有14例被诊断为前列腺癌,检出率为12．5％。4组中：检出前列腺癌病例分别为0、2、5、7例。血清PSA在0—1．9ng／ml和2．0—4．0ng／ml范围：DRE异常患者中前列腺癌检出率分别为5％和21．1％（P〈0．05）;TRUS异常患者中前列腺癌检出率分别为2．4％和28．6％（P〈0．05）。在14例前列腺癌患者中有4例仅被TRUS发现,并且这4例PSA值均在2．0～4．0ng／ml范围内。结论血清PSA〈2rig／ml时,除非DRE高度异常,患前列腺癌风险低,不需行前列腺穿刺活检。血清PSA在2．0—4．0ng／ml,应行TRUS检查,以提高前列腺癌检出敏感性。