经会阴B型超声引导下前列腺穿刺活检的临床价值研究

目的:探讨经会阴扇型B型超声引导下前列腺6针穿刺活检术诊断前列腺癌的临床价值。方法:对经直肠指检或经腹部B超检查发现前列腺结节、血清总前列腺特异性抗原(tPSA)在4μg/L以上或游离PSA(fPSA)/tP-SA<0.16的可疑前列腺癌104例患者,经会阴扇型B超引导下18G自动穿刺活检针行双侧叶6点法穿刺,对穿刺的阳性率和并发症及影响穿刺阳性率的因素进行分析。结果:经病理诊断,检出前列腺癌24例,检出率23%,前列腺癌分级评分中位数为7分,高分化癌(2~4分)、中分化癌(5~7分)和低分化癌(8~10分)分别为12.5%(3/24)、62.5%(15/24)和25%(6/24);其余80例为良性前列腺增生(BPH)。术后短暂和轻度的肉眼血尿5例(4.8%),均在1~3 d后缓解,4例(3.8%)发热37.2℃~38.0℃,术后会阴部轻度不适5例(4.8%)。术后无1例出现血便、血精、前列腺脓肿、高热、败血症、急性尿潴留等严重并发症。经分析发现tPSA、fPSA、fPSA/tPSA、前列腺抗原密度(PS-AD)和前列腺体积是影响前列腺穿刺阳性率的重要因素(P<0.05),经会阴穿刺优势主要反映在tPSA≥10μg/L、fP-SA≥2μg/L、fPSA/tPSA<0.16、PSAD≥0.2和前列腺体积<40 m l时提示应行会阴穿刺术。结论:经会阴扇型B型超声引导下6针前列腺穿刺活检,是一种安全准确的前列腺癌检出方法。

Clinical Value of Ultrasound Guided Transperineal Prostate Biopsy in Detecting Prostate Cancer

OBJECTIVE: To report our experience of ultrasound guided transperineal 6-core prostate biopsy (UG6CPB) in the diagnosis of prostate cancer (PCa). METHODS: In a prospective study, we performed UG6CPB in 104 suspected PCa patients with tPSA more than 4 microg/L and analysed the positive rate and complications of the diagnostic approach. RESULTS: PCa was detected in 24 of the 104 patients (23%), with low grade Gleason 2 to 4 in 3 cases (12.5%), intermediate grade Gleason 5 to 7 in 15 (62.5%) and high grade Gleason 8 to 10 in the remaining 6 (25%). Complications included temporary hematuria in 5 patients (4.8%), mild postbiopsy perineal discomfort in 5 (4.8%) and fever in 4 (3.8%). TPSA > or =10 microg/L, fPSA > or = 2 microg/L, fPSA/tPSA < 0.16, PSAD > or = 0.2 and prostate volume < 40 ml were the significant influencing factors of biopsy positive rate (P < 0.05). CONCLUSION: UG6CPB is an exact and a safe way of detecting PCa.