摘要
目的总结B超引导下经直肠前列腺穿刺的经验并分析影响前列腺穿刺结果的因素。方法统计卫生部北京医院1996--2007年行B超引导下经直肠前列腺穿刺病例。患者入选条件为前列腺特异抗原（PSA）〉4μL，和（或）直肠指检发现前列腺结节，和（或）B超或磁共振成像（MRI）检查发现前列腺异常信号者。对PSA4～10μg/L者结合游离PSA／总PSA比值≤0．16或PSA密度〉0．15决定是否进行穿刺。前列腺穿刺方案为6～12针。结果本组研究共有687例患者接受了前列腺穿刺，平均年龄（70±8）岁。诊断为前列腺癌者269例，平均年龄为（72±8）岁，其中接受前列腺癌根治术者99例，平均年龄（69±6）岁。因PSA升高就诊者总体占42．8％（294／687），发现前列腺结节者为121例（17．6％）。接受前列腺穿刺患者数量逐年增加，由1996年的10例增加到2007年的98例。总穿刺阳性率为39．8％，最高年度是1999年的60．0％（15／25），最低是2005年的30．4％（21／69）。穿刺阳性患者数呈逐年增加的趋势，最低的是1996年的4例，最高的是2007年的42例。PSA水平与穿刺阳性率呈正相关。应用游离PSA／总PSA比值显著提高了PSA介于4-10μg/L患者的前列腺穿刺阳性率（P〈0．05）。主要并发症血尿、大便表面带血、发热发生率分别为46．3％、8．7％、1．9％。结论结合PSA，游离PSA／总PSA比值和增加前列腺穿刺针数可以有效提高前列腺痛穿刺阳性率。经盲肠B超引导下前列腺穿刺活检诊断前列腺癌是安全有效的。
Objective To summarize the experience in ultrasound guided transrectal prostate biopsy and analyze the influencing factors of the biopsy results. Methods 687 patients with prostate specific antigen （PSA） 〉 4 μg, tubercles in prostate detected by digital rectal examination and/or prostate abnormality detected by magnetic resonance imaging, aged （70 ± 8 ）, underwent ultrasound guided transrectal 6-12 core prostate biopsy 1996 -2007. Since 2006 the criteria for biopsy included PSA of 4 - 10 μg/ml, free PSA/total PSA ratio （F/T ratio） ≤0.16, and PSA density 〉 0.15. Results 269 of the 687 cases, with the mean age of （72：1：8） , were diagnosed as with prostate cancer. 294 and 121 of the 687 patients （42.8% and 17.6% respectively） accepted prostate biopsy because of elevated PSA or abnormality of DRE. The number of patients accepting prostate biopsy increased yearly （ 10 cases in 1996 to 98 cases in 2007）. The positive biopsy rate was 39.8% , with the highest rate of 60.0% in 1999 and lowest rate of 30.4% in 2005. The highest number of prostate cancer diagnosed was the highest （42 cases） in 2007 and the lowest （4 cases） in 1996. PSA level was positively co-related with positive biopsy rate. The application of F/T ratio improved the positive biopsy rate in the patient with the PSA of 4- 10 μg/ml. The incidence rates of the main complications hematuria, bloody stool, and fever were 46. 3% , 8.7% , and 1. 9% respectively. Conclusion Elevated PSA has become the most common reason for prostate biopsy. The combination with PSA, F/T ratio, and increased biopsy core number improve the positive biopsy rate. The ultrasound guided transrectal prostate bioosv is efficient and safe in the diagaosis of nrostate cancer.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第14期955-957,共3页
National Medical Journal of China
关键词
前列腺肿瘤
穿刺术
经直肠
Prostate neoplasms
Punctures
Transrectal
