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.

TRUS guided transperineal biopsy of the prostate by using auto biopsy gun (Report of 484 cases)

Objective To increase the positive rate of TRUS guided transperineal prostate biopsy.Methods Patients with serum PSA>4ng/ml or with positive rectal examination results or abnormal findings found by sonography were performed transperineal sextant biopsy and more cores of the nodule.All the patients take the lithotomic position and are requested to expose the perineal zone.After local infiltration anesthesia by 10ml of 1% lidocaine,biopsy was performed at two points on both sides of the peripheral zone and one point on the transitional zone.There would be epactal 1 or 2 points on the suspicious area.315 cases of the group use the Aloka 700 ultrasonic machine and Manan Medical Products Promag2.2 auto-biopsy gun,the other 169 cases use the ESAOTE TechrosMPS ultrasonic machine and Bard Magnum 2.2 auto-biopsy gun.Results Among the 484 cases.The PSA level of 97 cases was below 4ng/ml,131 was from 4 to 10ng/ml,139 was from 10 to 20ng/ml,the other 117 cases was above 20ng/ml.The positive rate was 4.1%,19.8%,35.3%,80.3%,respectively.Positive predictive value was assessed on 484 consecutive TRUS guided transperineal biopsies.173 cases were prostate cancer.The total positive rate was 35.7%.The positive rate of the abnormal PSA group was 43.7%.The PIN rate was 7.5%.The positive rate of the Aloka group was 35.2%.The positive rate of the ESAOTE group was 36.7%.There was no statistical significant difference of positive rate between the two groups.Conclusion TRUS guided transperineal biopsy is an ideal method for the diagnose of prostate cancer which has a high accurate rate and fewer complications.