【摘要】 目的比较超声介导下经会阴及经直肠途径下前列腺穿刺活组织检查(活检)在前列腺穿刺活检中的应用价值。方法收集558例超声引导下前列腺穿刺活检病例临床资料,其中经会阴途径425例为经会阴组,经直肠途径133例为经直肠组。记录2组的穿刺活检结果,比较2组的PSA水平和活检阳性率差异,并对比PSA <10 ng/ml、10～30 ng/ml、> 30 ng/ml患者中2种方法的穿刺活检阳性率,观察2种方法的并发症发生情况。结果经会阴组和经直肠组的活检阳性率分别为40%(170/425)和44%(59/133),两者比较差异无统计学意义(P> 0.05)。在PSA <10 ng/ml、10～30 ng/ml、> 30 ng/ml的患者中,经会阴组前列腺癌活检阳性率分别为22%、26%、83%,经直肠组前列腺癌活检阳性率分别为24%、24%、84%,2组活检阳性率比较差异均无统计学意义(P均> 0.05)。2组间血尿、急性尿潴留、发热的发生率比较差异均无统计学意义(P均> 0.05),经直肠组的出血率高于经会阴组(P <0.001)。结论超声引导下经直肠途径和经会阴途径行前列腺穿刺活检均安全有效,其中经会阴途径穿刺活检的直肠出血风险更低。更多还原

【Abstract】 Objective To compare the clinical values of transperineal(TP) and transrectal(TR) ultrasound-guided prostate biopsy in the diagnosis of prostate cancer.Methods Clinical data of 558 patients undergoing ultrasound-guided prostate biopsy were collected.All patients were divided into the TP(n = 425) and TR groups(n = 133).The biopsy outcomes were recorded in two groups.The PSA level and positive rate were statistically compared between two groups.The positive rate in patients with PSA levels of < 10 ng/ml,10-30 ng/ml and > 30 ng/ml was compared between two biopsy methods.The incidence of complications was observed in two groups.Results The positive rate of prostate cancer was 40%(170/425) in the TP group and 44.4%(59/133) in the TR group with no significant difference(P > 0.05).In the TP group,the positive rate of prostate cancer in patients with PSA levels of < 10 ng/ml,10-30 ng/ml and > 30 ng/ml was 22%,26% and 83%,which did not significantly differ from 24%,24% and 84% in the TR group(all P > 0.05).The incidence of hematuria,acute urinary retention and fever did not significantly differ between two groups(all P > 0.05),whereas the risk of rectal bleeding through transrectal route was remarkably higher than that of the perineal route(P < 0.001).Conclusion Both TP and TR prostate biopsy methods are safe and efficacious,and TP approach can lower the risk of rectal bleeding.更多还原