【摘要】 目的:评估在直肠超声引导下经直肠与经会阴2种途径行前列腺穿刺活检术在前列腺癌(PCa)检出率以及围手术期并发症等方面的差异。方法:回顾性分析2014年10月～2017年10月我院因PCa待排就诊并符合纳入标准的255例患者的临床资料,所有患者符合前列腺穿刺活检指征。本研究分为两组,2014年10月～2016年5月130例患者接受经直肠前列腺穿刺活检术(经直肠组),2016年6月～2017年10月125例患者接受经会阴前列腺穿刺活检术(经会阴组)。所有患者首次穿刺活检均为系统性穿刺12针,本研究排除了穿刺不同针数的病例以减少偏差,综合分析2种穿刺活检方式的各种指标,包括患者年龄、总PSA(tPSA)、游离PSA(fPSA)、DRE/TRUS检查结果、PCa检出率以及并发症等围手术期各项指标。结果:255例PCa待排患者中,经过病理结果确认,经直肠组诊断为PCa的患者为43.85%(57/130),经会阴组诊断为PCa的患者为50.40%(63/125),两组比较差异无统计学意义。分层分析发现,经会阴组Gleason评分≥7分PCa检出率明显高于经直肠组,在PSA<4ng/ml、f/t≥0.15、TRUS检查阴性的患者中,经会阴组的PCa检出率明显高于经直肠组,而在PSA≥4ng/ml、f/t<0.15、TRUS检查阳性的患者中经直肠组明显高于经会阴组;在DRE异常的患者中,经会阴组的PCa检出率明显高于经直肠组。经直肠组手术时间为(10.15±3.06)min,经会阴组手术时间为(11.27±0.15)min,两组比较差异无统计学意义;经直肠组和经会阴组术后患者出现肉眼血尿的比例分别为6.92%(9/130)和19.20%(24/125),经直肠组和经会阴组出现尿潴留的比例分别为3.85%(5/130)和17.60%(22/125),两组比较差异均有统计学意义(P<0.05);经直肠组和经会阴组直肠出血发生率分别为24.62%(32/130)和0,两组比较差异有统计学意义(P<0.05);经直肠组和经会阴组术后感染发生率分别为14.62%(17/130)和1.60%(2/125),两组比较差异有统计学意义(P<0.05);经直肠组和经会阴组视觉模拟评分(VAS)分别为(1.17±0.19)分和(2.07±1.08)分,两组比较差异无统计学意义。结论:在经直肠超声引导下不论是经直肠前列腺穿刺活检术还是经会阴前列腺穿刺活检术,在临床上都是安全可行的。经会阴前列腺穿刺活检术在低度可疑PCa检出率方面具有更多优势,具有术后并发症更少等优点,在临床中值得进一步推广。更多还原

【Abstract】 Objective:To compare the difference in the prostate cancer detection and peri-operative complications between transrectal ultrasound(TRUS)guided transrectal and transperineal prostate biopsy.Method:A retrospective analysis was performed on 255 patients with prostate cancer in our center from October 2014 to October2017.All patients had indications for prostate biopsy.These patients were divided into two groups,from October2014 to May 2016,130 cases were performed TRUS guided transrectal prostate biopsy(transrectal group),and from June 2016 to October 2017,other 125 cases underwent TRUS guided transperineal prostate biopsy(transperineal group).Systematic 12-core biopsy was performed for the first time.This study excludes the different cores of cases to reduce the deviation.Various indexes of two types of biopsy,including patients’ age,total PSA and free PSA,DRE/TURS test results,the detection rate of prostate cancer and peri-operative complications were analyzed.Result:In all 255 cases,patients diagnosed with prostate cancer in transrectal group was 43.85%(57/130),while in transperineal group was 50.40%(63/125).There was no significant statistical difference between two groups.In stratified analysis,we found that the transperineal group in Gleason score 7 or higher patients,the detection of prostate cancer was significantly higher than that in transrectal group.For PSA<4 ng/ml,f/t≥0.15,TRUS negative patients,prostate cancer detection in transperineal group was obviously higher than that in transrectal group.In patients with DRE abnormalities,the detection of prostate cancer in transperineal group was significantly higher than that in transrectal group.About operating time,the transrectal group was(10.15±3.06)min,and transperineal group was(11.27±0.15)min,which there was no statistically significant difference between the two groups.Postoperative haematuria in the transrectal group and the transperineal group were 6.92%(9/130)and 19.20%(24/125),respectively.In terms of urinary retention,3.85%(5/130)and 17.60%(22/125)were found in the transrectal group and transperineal group,while the blood in the stool was 24.62%(32/130)and 0(0/125)in the transrectal group and the transperineal group,respectively.The postoperative infection was 14.62%(17/130)and 1.60%(2/125)in transrectal and transperineal group respectively.About the visual analogue scale(VAS),there was no statistically significant difference between the two groups.Conclusion:TRUS guided prostate biopsy is safe and feasible in clinical practice,whether in transrectal or transperineal way.Transperineal biopsy has more advantages of higher detection rate of low suspected prostate cancer and less postoperative complications,so it is worthy of further promotion in clinical practice.更多还原