Clinical study of perineal prostatic puncture biopsy under "X+2+3" mode of local anesthesia
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摘要: 目的 比较改良模式局部麻醉与常规局部麻醉、静脉麻醉3种不同麻醉方式下行超声引导下经会阴前列腺穿刺活检术的效果与安全性，评估改良模式局部麻醉下行经会阴前列腺穿刺活检术的临床应用价值。方法 回顾分析于滕州市中心人民医院行超声引导下经会阴前列腺穿刺活检的180例患者，分为3组，全麻组60例：静脉麻醉下行经会阴前列腺穿刺活检术；改良组60例：“X+2+3”改良模式局部麻醉行经会阴前列腺穿刺活检术；常规组60例：常规会阴区皮下及前列腺周围神经阻滞麻醉行经会阴前列腺穿刺活检术。3组患者均行12针系统穿刺+认知融合靶向穿刺。收集3组患者的一般临床资料(年龄、体重指数、前列腺特异性抗原、前列腺健康指数、前列腺体积、麻醉ASA分级等)，分析比较3组患者穿刺活检术的相关临床指标(穿刺针数、麻醉时间、穿刺时间、出入室时间、疼痛评分、手术并发症、前列腺癌检出率、住院天数、住院费用、患者满意度情况等)，采用χ2检验、t检验方法进行统计学分析。结果 3组患者一般临床资料间差异均无统计学意义(P>0.05)；3组患者均完成前列腺穿刺活检。改良组在麻醉中及穿刺过程中的t3及t5时间点疼痛评分均较常规组偏低(P < 0.05)；3组间穿刺针数、穿刺时间、术后疼痛评分差异均无统计学意义(P>0.05)；改良组及常规组出入室时间比较差异无统计学意义(P>0.05)，但均显著短于全麻组(P < 0.001)；改良组在迷走神经反射并发症发生率上低于常规组(P < 0.05)，而与全麻组比较差异无统计学意义(P>0.05)；改良组与常规组在急性尿潴留、呼吸困难、咳嗽、咳痰并发症发生率方面比较，差异无统计学意义(P>0.05)，但均低于全麻组(P < 0.05)，其余并发症在3组间差异无统计学意义。3组的前列腺癌检出率差异无统计学意义(P>0.05)；改良组与常规组住院天数、住院费用均显著少于全麻组(P < 0.001)；常规组与全麻组患者满意度差异无统计学意义(P>0.05)，但均低于改良组(P < 0.05)。结论 “X+2+3”改良模式局部麻醉行超声引导下经会阴前列腺穿刺活检术安全、有效，显著缩短了平均住院日，减轻了患者经济负担，提高了患者满意度，具有较高的临床应用价值。
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关键词:
- 前列腺癌 /
- 经会阴前列腺穿刺活检术 /
- 静脉麻醉 /
- 会阴皮肤局部麻醉 /
- 前列腺周围神经阻滞麻醉 /
- 肛周神经阻滞麻醉
Abstract: Objective To compare the efficacy and safety among ultrasound-guided transperineal prostate biopsy under improved local anesthesia, conventional local anesthesia and intravenous anesthesia, and evaluate the clinical application value of transperineal prostate biopsy under improved local anesthesia.Methods A retrospective analysis was made on 180 patients who underwent transperineal prostate biopsy under ultrasound guidance in Tengzhou Central People's Hospital, and they were divided into 3 groups, 60 cases in the general anesthesia group: transperineal prostate biopsy under intravenous anesthesia; 60 cases of improved local anesthesia group: perineal prostate puncture biopsy under "X+2+3" modified mode of local anesthesia; 60 cases of routine local anesthesia: perineal prostate puncture biopsy under perineal subcutaneous and periprostatic nerve block anesthesia. All the three groups underwent 12-needle systematic puncture + cognitive fusion targeted puncture. General clinical data(age, body mass index, prostate-specific antigen, prostate health index, prostate volume, anesthesia ASA grade, etc.) of the three groups were collected. The relevant clinical indexes(number of puncture needles, anesthesia time, puncture time, exit and entry time, pain score, surgical complications, detection rate of prostate cancer, average length of stay, hospitalization cost, patient satisfaction, etc.) of the three groups were analyzed and statistically analyzed by Chi-square test and t-test.Results There was no significant difference in general clinical data among the three groups(P>0.05). Prostate biopsy was completed in all three groups. The pain scores of t3 and t5 during anesthesia and puncture in the improved group were lower than those in the conventional group(P < 0.05). There were no significant differences in the number of puncture needles, puncture time or postoperative pain score among the three groups(P>0.05). There was no significant difference in exit and entry time between the improved group and the conventional group(P>0.05), but it was significantly shorter than that of the general anesthesia group(P < 0.001). The incidence of vagal reflex complications in the improved group was lower than that in the conventional group(P < 0.05), but there was no significant difference between the improved group and the general anesthesia group(P>0.05). The incidence of acute urinary retention, dyspnea, cough and expectoration complications in the improved group and the conventional group was not different(P>0.05), but lower than that in the general anesthesia group(P < 0.05). There was no significant difference in other complications among the three groups. There was no significant difference in the detection rate of prostate cancer among the three groups(P>0.05). The hospitalization days and hospitalization expenses of the improved group and the conventional group were significantly lower than those of the general anesthesia group(P < 0.001). There was no difference in patient satisfaction between the conventional group and the general anesthesia group(P>0.05), but the satisfaction was lower than that of the improved group(P < 0.05).Conclusion Ultrasound-guided transperineal prostate biopsy under "X+2+3" modified local anesthesia is safe and effective, significantly shortening the average length of hospital stay, reducing the economic burden of patients, and improving patient satisfaction, which has high clinical application value. -
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表 1 3组患者一般临床资料比较
例，X±S 组别 例数 年龄/岁 BMI/(kg/m2) PSA/(μg/L) PHI 前列腺体积
/mLASA分级 Ⅰ级 Ⅱ级 常规组 60 69.33±9.07 22.42±4.35 19.00±15.91 33.43±22.95 41.23±14.99 34 26 改良组 60 68.97±9.92 22.66±4.16 18.95±16.18 32.95±19.64 39.97±14.43 33 27 全麻组 60 68.60±9.39 22.72±4.22 22.98±20.40 32.87±22.38 37.64±15.33 35 25 t/χ2 0.108 0.084 1.033 0.012 0.893 0.136 P值 0.898 0.919 0.358 0.988 0.411 0.934 
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表 2 3组患者之间各项评估指标的比较
例(%)，X±S 项目 常规组(60例) 改良组(60例) 全麻组(60例) χ2/t P值 穿刺针数/针 15.43±1.42 15.22±1.34 15.53±1.19 0.904 0.407 穿刺时间/min 6.12±1.74 5.80±1.75 5.50±1.80 1.840 0.162 出入室时间/min 15.70±1.97 15.33±1.86 20.13±3.191)2) 73.540 < 0.001 术后1 h疼痛评分/分 1.70±1.56 1.12±1.381) 1.07±1.471) 3.442 0.034 术后并发症 血尿 3(5.00) 3(5.00) 4(6.67) 0.212 0.900 血便 5(8.33) 3(5.00) 2(3.33) 1.482 0.477 血精 4(6.67) 3(6.67) 2(3.33) 0.702 0.704 局部血肿 3(5.00) 2(3.33) 1(1.67) 1.034 0.596 感染 2(3.33) 2(3.33) 1(1.67) 0.411 0.814 迷走神经反射 5(8.33) 0(0)1) 0(0)1) 7.241 0.027 急性尿潴留 2(3.33) 2(3.33) 12(20.00)1)2) 8.086 0.004 勃起功能障碍 5(8.33) 6(10.00) 8(13.33) 0.824 0.662 呼吸困难 0(0) 0(0) 6(10.00)1)2) 6.316 0.014 咳嗽、咳痰 0(0) 0(0) 4(6.67)1)2) 8.182 0.017 前列腺癌检出率 26(36.67) 28(46.77) 31(51.77) 0.847 0.655 住院天数/d 1.62±0.74 1.50±0.75 3.17±1.201)2) 9.155 < 0.001 住院费用/元 2 543.00±414.70 2 539.00±431.60 3 367.00±563.901)2) 9.037 < 0.001 患者满意度 51(85.00) 58(96.67)1) 52(86.67)2) 5.060 0.050 与常规组比较，1)P < 0.05；与改良组比较，2)P < 0.05。
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