Analysis of clinical data of 1054 cases of transperineal prostate biopsy guided by rectal ultrasound
-
摘要: 目的 总结直肠超声引导下经会阴前列腺穿刺活检术的前列腺癌诊出率及安全性。方法 回顾性分析2015年1月—2019年12月河南省人民医院直肠超声引导下经会阴前列腺穿刺活检术患者的年龄、前列腺穿刺术前总前列腺特异抗原(tPSA)、游离前列腺特异抗原(fPSA)、临床病理、前列腺大小、穿刺并发症。结果 本研究共纳入1054例患者，平均年龄(69.25±8.88)岁；其中前列腺癌穿刺阳性582例(55.22%)。患者年龄越大，穿刺阳性率越高(P＜0.05)；术前tPSA水平越高，穿刺阳性率越高(P＜0.05)。当tPSA水平处于4~10 ng/mL，前列腺穿刺阳性率为27.54%；当f/t＜0.16，穿刺阳性率提高到39.77%，且f/t比值越低，穿刺阳性率越高(P＜0.05)；tPSA水平越高，患高危前列腺癌的可能性越大(P＜0.05)。1054例患者术中及术后均未发生严重并发症，尿潴留、会阴小血肿、发热、血尿、疼痛的发生率分别为1.71%、2.18%、2.56%、36.32%、22.39%。结论 直肠超声引导下经会阴前列腺穿刺术具有诊出率高、并发症少的特点，值得临床推广。Abstract: Objective To summarize the diagnostic rate and safety of transperineal prostate biopsy guided by rectal ultrasound.Methods The clinical data of patients undergoing transperineal prostate biopsy guided by transrectal ultrasound in Henan Provincial People's Hospital from January 2015 to December 2019 were retrospectively analyzed, including age, total prostate specific antigen (tPSA), free prostate specific antigen (fPSA), clinical pathology, prostate size and puncture complications.Results A total of 1054 patients were included in this study, with an average age of (69.25±8.88) years old. Among them, 582 cases (55.22%) were positive for prostate cancer. The results showed that the older the patient, the higher the positive rate of puncture (P < 0.05). The higher the level of tPSA, the higher the positive rate of puncture (P < 0.05). When tPSA was 4-10 ng/mL, the positive rate of prostate puncture was 27.54%. When f/t was less than 0.16, the positive rate of prostate puncture could be increased from 27.54% to 39.77%. The lower the ratio, the higher the positive rate of prostate puncture (P < 0.05). The results showed that the higher the tPSA level, the higher the risk of prostate cancer (P < 0.05). No serious complications occurred in 1054 patients during and after operation. The incidence of urinary retention, perineal hematoma, fever, hematuria and pain were 1.71%, 2.18%, 2.56%, 36.32% and 22.39% respectively.Conclusion The transperineal prostate puncture guided by rectal ultrasound has the characteristics of high diagnosis rate and less complications, which is worth popularizing.
-
-
表 1 不同年龄患者前列腺癌检出情况
例(%) 年龄/岁 例数 前列腺癌 非前列腺癌 ＜50 22 4(18.18) 18(81.82) 50~59 123 58(47.15) 65(52.85) 60~69 375 185(49.33) 190(50.67) 70~79 410 247(60.24) 163(39.76) ≥80 124 88(70.97) 36(29.03) 合计 1054 582(55.22) 472(44.78) 
下载: 导出CSV
表 2 不同tPSA水平分组患者前列腺癌检出情况
例(%) tPSA水平/ (ng·mL-1) 例数 前列腺癌 非前列腺癌 ＜4.00 68 11(16.18) 57(83.82) 4.00~9.99 207 57(27.54) 150(72.46) 10.00~19.99 264 114(43.18) 150(56.82) 20.00~49.99 185 101(54.59) 84(45.41) 50.00~99.99 92 68(73.91) 24(26.09) ≥100.00 238 231(97.06) 7(2.94) 合计 1054 582(55.22) 472(44.78)
下载: 导出CSV
表 3 前列腺癌患者不同tPSA水平分组高危前列腺癌检出情况
例(%) tPSA水平/ (ng·mL-1) 例数 高危前列腺癌 低中危前列腺癌 ＜4.00 11 5(45.45) 6(55.55) 4.00~9.99 57 18(31.58) 39(68.42) 10.00~19.99 114 48(42.11) 66(57.89) 20.00~49.99 101 65(64.36) 36(35.64) 50.00~99.99 68 50(73.53) 18(26.47) ≥100.00 231 208(90.04) 23(9.96) 合计 582 394(67.70) 188(32.30)
下载: 导出CSV
表 4 不同f/t分组前列腺癌检出情况
例(%) f/t 总例数 前列腺癌 非前列腺癌 ＜0.1 43 19(44.19) 24(55.81) 0.1≤f/t＜0.16 45 16(35.56) 29(64.44) 0.16≤f/t＜0.2 49 10(20.41) 39(79.59) ≥0.2 70 12(17.14) 58(82.86) 合计 207 57(27.54) 150(72.46)
下载: 导出CSV
-
[1] 李星, 曾晓勇. 中国前列腺癌流行病学研究进展[J]. 肿瘤防治研究, 2021, 48(1): 98-102. doi: 10.3971/j.issn.1000-8578.2021.20.0370
[2] Berry B, Parry MG, Sujenthiran A, et al. Comparison of complications after transrectal and transperineal prostate biopsy: a national population-based study[J]. BJU Int, 2020, 126(1): 97-103. doi: 10.1111/bju.15039
[3] Thomson A, Li M, Grummet J, et al. Transperineal prostate biopsy: a review of technique[J]. Transl Androl Urol, 2020, 9(6): 3009-3017. doi: 10.21037/tau.2019.12.40
[4] Xiang J, Yan H, Li J, et al. Transperineal versus transrectal prostate biopsy in the diagnosis of prostate cancer: a systematic review and meta-analysis[J]. World J Surg Oncol, 2019, 17(1): 31. doi: 10.1186/s12957-019-1573-0
[5] 严维刚, 李汉忠, 纪志刚, 等. 经会阴模板定位前列腺11区饱和穿刺活检: 附2066例分析[J]. 协和医学杂志, 2012, 3(2): 190-194. doi: 10.3969/j.issn.1674-9081.2012.02.013
[6] 郭应禄, 那彦群, 叶章群, 等. 中国泌尿外科和男科疾病诊断治疗指南[M]. 北京: 科学出版社, 2019: 85-133.
[7] Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent[J]. Eur Urol, 2017, 71(4): 618-629. doi: 10.1016/j.eururo.2016.08.003
[8] Bey E, Gaget O, Descotes JL, et al. Transrectal ultrasound-guided prostate biopsies vs. magnetic resonance imagingultrasound fusion targeted biopsies: Who are the best candidates?[J]. Can Urol Assoc J, 2018, 12(1): E10-E14.
[9] Huang GL, Kang CH, Lee WC, et al. Comparisons of cancer detection rate and complications between transrectal and transperineal prostate biopsy approaches-a single center preliminary study[J]. BMC Urol, 2019, 19(1): 101. doi: 10.1186/s12894-019-0539-4
[10] 陈争光, 顾朝辉, 董刚, 等. 经直肠超声引导下前列腺穿刺术后并发症的危险因素研究[J]. 中华实验外科杂志, 2017, 34(4): 691-693. doi: 10.3760/cma.j.issn.1001-9030.2017.04.051
[11] 郭飞, 刘久敏, 蒲小勇, 等. 超声引导下12+x针前列腺穿刺活检单中心407例临床分析[J]. 临床泌尿外科杂志, 2021, 36(1): 12-17. http://lcmw.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=c5c88bfa-6d73-41ed-bf2d-5cea46261b32
[12] Stefanova V, Buckley R, Flax S, et al. Transperineal Prostate Biopsies Using Local Anesthesia: Experience with 1, 287 Patients. Prostate Cancer Detection Rate, Complications and Patient Tolerability[J]. J Urol, 2019, 201(6): 1121-1126. doi: 10.1097/JU.0000000000000156
[13] Chen Y, Zhou Z, Zhou Y, et al. Development and internal validation of a prediction model of prostate cancer on initial transperineal template-guided prostate biopsy[J]. BMC Urol, 2021, 21(1): 68. doi: 10.1186/s12894-021-00840-5
[14] 胡梦博, 杨天, 吴亦硕, 等. 前列腺穿刺结果的多参数预测列线图模型建立: 上海单中心1585例经会阴前列腺穿刺回顾[J]. 复旦学报(医学版), 2020, 47(1): 12-18. doi: 10.3969/j.issn.1672-8467.2020.01.003
[15] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. doi: 10.3322/caac.21492
[16] Halpern JA, Oromendia C, Shoag JE, et al. Use of Digital Rectal Examination as an Adjunct to Prostate Specific Antigen in the Detection of Clinically Significant Prostate Cancer[J]. J Urol, 2018, 199(4): 947-953. doi: 10.1016/j.juro.2017.10.021
[17] Al-Yasiri AY, White NE, Katti KV, et al. Estimation of tumor and local tissue dose in gold nanoparticles radiotherapy for prostate cancer[J]. Rep Pract Oncol Radiother, 2019, 24(3): 288-293. doi: 10.1016/j.rpor.2019.02.006
[18] Vezyraki P, Vlachaki A, Baltogiannis D, et al. Impact of total PSA and percent free PSA in the differentiation of prostate disease: a retrospective comparative study implicating neoplastic and non-neoplastic entities[J]. J BUON, 2019, 24(5): 2107-2113.
[19] Marra G, Gontero P, Valerio M. Changing the prostate cancer management pathway: why Focal Therapy is a step forward[J]. Arch Esp Urol, 2016, 69(6): 271-280.
[20] Kasivisvanathan V, Rannikko AS, Borghi M. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis[J]. N Engl J Med, 2018, 378(19): 1767-1777. doi: 10.1056/NEJMoa1801993
[21] 李德润, 刘毅, 李志华, 等. 磁共振与经直肠超声认知融合引导的经直肠前列腺靶向穿刺活检614例单中心临床研究[J]. 生物医学工程学杂志, 2020, 37(2): 225-229. https://www.cnki.com.cn/Article/CJFDTOTAL-SWGC202002007.htm
[22] 彭毓璐, 麦海星, 董金凯, 等. 超声引导下经会阴前列腺穿刺活检与经直肠穿刺活检安全性研究[J]. 微创泌尿外科杂志, 2018, 7(2): 112-115. https://www.cnki.com.cn/Article/CJFDTOTAL-WCMN201802012.htm
-