10点及以上与10点以下经会阴前列腺穿刺活检并发症的比较

目的比较10点及以上和10点以下超声引导经会阴前列腺穿刺活检的并发症发生率。方法复旦大学附属中山医院2009年1月～2010年4月共进行直肠超声引导经会阴前列腺穿刺活检613例，随访540例，其中60岁及以上完成514例。按穿刺针数分组，514例中10点及以上组200例，10点以下组314例。10点及以上组穿刺针数10～12针，10点以下组穿刺针数6～9针。通过电话随访患者出血、感染、下尿路症状、术中疼痛不适等并发症的发生情况。结果各种并发症发生率如下：血尿和／或尿道流血10点及以上组122例（61．0％），10点以下组186例（59．2％）；其中因血尿或尿道流血需膀胱连续冲洗者10点及以上组1例（0．5％），10点以下组2例（0．6％）；血尿或尿道流血持续时间10点及以上组（3．86±0．26）d，10点以下组（4．11±0．21）d。发热（≥38℃）10点及以上组5例（2．5％），10点以下组5例（1．6％）。术后新出现下尿路症状或原有症状较术前加重者10点及以上组66例（33．0％），10点以下组97例（30．9％）。术后急性尿潴留10点及以上组1例（0．5％），10点以下组2例（0．6％）。术中非常疼痛不适者10点及以上组13例（6．5％），10点以下组22例（7．0％）。两组比较，并发症差异均无统计学意义。两组随访中均未发现感染性休克、盆腔血肿等严重并发症。结论10点及以上与10点以下经会阴前列腺穿刺活检比较，并发症的发生率无显著增加，同样是安全、可靠的。通过提高穿刺技术和完善术前术后处理可以进一步减少并发症的发生。

Comparison of the complications between more than and less than 10-cores transperineal prostate biopsy

Objective To compare the complications of transperineal prostate biopsy between more than and less than 10-core groups. Methods 613 patients underwent transrectal ultrasound guided transperineal prostate biopsy from January 2009 to April 2010 and 540 patients were followed up. Among whome 514 patients aged more than 60 years old. All these 514 patients were divided into two groups： more than 10 cores group （group A, 200 cases） and less than 10 cores group （group B, 314 cases）. Complications, which included hematuria, infection, lower urinary symptoms and pain, were evaluated and compared between the two groups. Results Hematuria and/or urethral bleeding were detected in 122 cases （61.0 %） of group A and 186 cases （59.2 %） of group B. Severe hematuria was detected in 1 （0.5%） versus 2 （0.6 %） cases respectively. And hematuria remained 3.86＋0.26 versus 4.15：0.21 days in group A and B. Fever （≥ 38 ℃） ourred in 5 （2.5 %） versus 6 （1.8 %）, respectively. LUTS were found in 66 （33.0 %） versus 97 （30.9%） cases, of which acute urinary retention occurred in 1 （0.5 %） versus 2 （0.6 %） cases. Unacceptable discomfort was found in 13 （6.5 %） versus 22 （7.0%） cases of group A and B, respectively. Of all complications, only the rate of fever between the two groups was statistically different. Severe complications such as infectious shock or pelvic hematoma were not found in both groups. Conclusions More than 10-cores transperineal prostate biopsy is a safe and efficacy technique without increasing complication rates compared with less than 10-cores technique. The incidence of complications can be reduced via improving the biopsy techniques.