| 摘要: |
| 目的 探讨直肠超声引导下前列腺穿刺活检术的安全性及诊断价值。方法 2005年6月至2014年8月共3 256例男性患者在我院泌尿外科行直肠超声引导的前列腺穿刺活检术。每个患者均检测PSA和前列腺体积。穿刺点数一般为12点,每个标本分别标记送病理检查,Gleason 评分用于评估肿瘤分级。结果 活检组织病理诊断为前列腺癌1 112例,阳性率为34.2%,前列腺癌患者PSA中位均数为22.8 ng/ml,Gleason中位均数为7。当总PSA≤4 ng/ml、4-10 ng/ml、10-20 ng/ml、20-50 ng/ml以及>50 ng/ml时,前列腺癌活检阳性率分别为10.1%(11/109)、17.3%(212/1 226)、23.8%(261/1 098)、54.6%(179/328)和90.7%(449/495)。所有前列腺癌中PSA<20 ng/ml占43.5%。术后6例患者出现高热(>38.5℃),其中2例出现败血症,经积极抗感染治疗后所有患者均痊愈；45例患者出现直肠出血,但严重出血需要压迫止血仅2例；其他并发症均不严重,对症治疗后完全恢复,无后遗症。结论 直肠超声引导下前列腺广泛活检术安全有效；虽然受到不断更新的穿刺活检技术的挑战,但就目前而言直肠超声引导下前列腺广泛活检联合前列腺特异性抗原筛查仍然是国人前列腺癌早期诊断的首选手段。 |
| 关键词: 前列腺肿瘤 前列腺特异抗原 经直肠超声检查 活组织检查 |
| DOI：10.3724/SP.J.1008.2015.00799 |
| 投稿时间：2015-02-25修订日期：2015-05-04 |
| 基金项目:国家自然科学基金(81070602),中国博士后科学基金面上项目第55批(43655). |
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| Transrectal ultrasound-guided prostate biopsy: a single center report of 3 256 cases |
| FANG Liang1△,XU Wei-ming2△,CHEN Guang-hua3,SHI Min-feng4*,ZHOU Tie3* |
(1. Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Department of Urology, People's Hospital of Haining, Haining 314400, Zhejiang, China;
3. Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
4. Infertility Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding authors) |
| Abstract: |
| Objective To investigate the safety of transrectal ultrasound guided prostate biopsy (TUPB)and its role in early diagnosis of prostate cancer(PCa) by analyzing the large sample data of a single center. Methods Between June 2005 and August 2014, 3256 consecutive patients with an age range from 50 to 80 years (average 69 years),underwent TUPB at Changhai hospital. Prostate specific antigen (PSA) and prostate volume was evaluated; and 12 cores biopsy was undertaken with separate Gleason score evaluation for each core.Student’s t test was used for statistically analysis. Results The positive predictive value (PPV) of cancer was 34.2%, and the median PSA and Gleason score of PCa patients were 22.8 ng/ml and 7. When the PSA value ranged less than 4.0, 4.1-10.0, 10.1-20.0, 20.1-50.0 ng/ml and 50.0ng/ml or more, PPV was 10.1%, 17.3%, 23.8%, 54.6%, and 90.7%, respectively. Of all the patients with PCa, 43.5% had PSA less than 20ng/ml.A total of 6 patients had infection and of them 2 patient had severe sepsis; 45 patients had rectal bleeding but only 2 patients needed treatment; the other minor complications were acute urine retention,haematouria and vasovagal syncope. All the patients convalesced without sequela. Conclusions TUPB is safe and effective and combination with PSA screen is still the standard for early diagnosis of PCa in China so far, regardless of continuous challenging from upto-date biopsy technique. |
| Key words: prostatic neoplasms prostate-specific antigen transrectal ultrasound biopsy |
