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.

Application of transperineal biopsy of the prostate guided by contract-enhanced transrectal ultrasound

Objective To investigate the clinical significance of contrast-enhanced transrectal ultrasound(CE-TRUS) in the perineal prostate biopsy. Methods A total of 116 patients was undergone prostate biopsy through the perineum under the direction of tansrectal ultrasound. Prostate biopsy standard was based on 2007 CUA revised guidelines for diagnosis and treatment of urological diseases.Color Doppler ultrasonography was used to check the prostate and to learn the prostate focal lesion,size, number and echo color Doppler flow characteristics. Of the 116 cases, 43 patients was undergone contrast-enhanced transrectal ultrasound. Results The biopsy results confirmed the diagnosis of prostate cancer was 64 cases, Benign prostatic hyperplasia was 52 cases. Of 43 cases who undergone contrast-enhanced transrectal ultrasound, Prostate cancer and Benign prostatic hyperplasia were 25 and 18 cases, respectively. CE-TRUS group and TRUS group showed no statistical difference between two groups. Analyzed the cases with PSA≤30 ng/ml, CE-TRUS group had a higher positive rate of biopsy (P=0.046). Conclusion TRUS guided transperineal biopsy of prostate might be an method for the diagnosis of prostate cancer with a higher accuracy rate. CE-TRUS can improve the biopsy positive rate of prostate cancer.