经会阴模板定位前列腺11区饱和穿刺活检：附2066例分析

目的探讨经直肠超声引导下经会阴模板定位前列腺饱和穿刺活检的准确性与安全性。方法选择北京协和医院2066例前列腺特异性抗原（prostate specific antigen,PSA）〉4.0ng/ml和/或直肠指检异常和/或前列腺B超、CT或MRI异常者接受饱和穿刺活检,根据前列腺解剖特点,分11区穿刺活检。患者年龄26～92岁,平均70.2岁;PSA0.2～5000ng/ml,中位数11.7ng/ml;前列腺体积7～450ml,中位数45.0ml。结果每区活检1～4针,共11～44针,平均18.7针。前列腺癌活检阳性率39.3%（812/2066）,PSA0～4.0、4.1～10.0、10.1～20.0、20.1～50.0、50.1～100.0及〉100.1ng/ml活检者阳性率分别为24.1%（28/116）、18.9%（140/739）、30.4%（192/631）、56.3%（148/263）、84.5%（130/142）及99.4%（174/175）。术后血尿发生率为38.0%（785/2066）,急性尿潴留2.1%（42/2066）,感染性休克0.05%（1/2066）。全组无死亡病例。结论经直肠超声引导下经会阴模板定位饱和穿刺活检精确而安全,对于早期前列腺癌的准确分期及治疗方案选择有重要意义。

Transperineal Ultrasound Guided Template Saturation Prostate Biopsy:Report of 2066 Cases

Objective To assess the efficacy and safety of transperineal ultrasound guided template saturation prostate biopsy.Methods In a prospective study,a total of 2066 patients (26-92 years old,mean:70.2 years) who met the inclusion criteria underwent transperineal ultrasound guided saturation prostate biopsy using an 11-region template.The inclusion criteria included:a prostate specific antigen (PSA) level of 4.0 ng/ml or greater and abnormal prostate gland findings on digital rectal examination,ultrasound,CT,and/or MRI.Of these 2066 patients,the median PSA level was 11.7 ng/ml (range:0.2-5000 ng/ml) and the median prostate volume was 45.0 ml (range:7-450 ml).Results Prostate cancer was detected in 812 of 2066 patients (39.3%).The prostate cancer detection rates in groups with PSA 0-4.0,4.1-10.0,10.1-20.0,20.1-50.0,50.1-100.0,and >100.1 ng/ml groups were 24.1%(28/116),18.9%(140/739),30.4%(192/631),56.3%(148/263),84.5% (130/142),and 99.4%(174/175),respectively.Among all these 2066 patients,785 (38.0%)had mild and transient (1 to 7 days) hematuria,42 (2.1%)had urinary retention,and 1 (0.05%)had septic shock postoperatively.No patient died during the procedure.Conclusion Transperineal ultrasound guided template saturation prostate biopsy is a safe and accurate procedure and can be useful for the precise TNM staging and the treatment decision-making.