经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的对比分析

doi:10.3969/j.issn.1006-7795.2021.03.022

摘要/Abstract

摘要： 目的对比经会阴前列腺穿刺术(transperineal prostate biopsy, TPPB)和经直肠前列腺穿刺术(transrectal prostate biopsy, TRPB)在前列腺穿刺中的优劣。方法收集首都医科大学附属北京朝阳医院2018年1月至2020年1月行超声引导下局部麻醉前列腺穿刺术的患者共237例,其中2018年1月至2019年6月,185例患者采用TRPB,2019年7月至2020年1月52例患者采用TPPB。结果对两组患者围手术期资料进行比较。TPPB组和TRPB组的患者年龄分别为(68.2±9.2)岁和(69.7±8.1)岁(P=0.331);体质量指数分别为(24.7±3.3) kg/m²和(24.7±3.1) kg/m²(P=0.924);查尔森合并症指数分别为2.7±1.7和2.8±1.1(P=0.744);前列腺体积为(59.5±32.0) cm³和(65.9±28.7) cm³(P=0.512);国际前列腺症状评分(International Prostate Symptom Score,IPSS)分别为10.3±4.7和10.2±5.0(P=0.960),以上差异均无统计学意义。术前实验室检查等方面的差异均无统计学意义(P＞0.05)。所有手术均顺利完成,术后7 d内TPPB组和TRPB组分别出现33例次和145例次并发症,均为Clavien-Dindo 1级。两组在穿刺针数、穿刺阳性针数、穿刺病理恶性例数、Gleason评分、临床意义前列腺癌检出例数、血尿、下尿路症状、血精症和其他并发症等方面差异均无统计学意义(P>0.05)。TPPB组的手术时间长于TRPB组,穿刺点出血少于TRPB组(P=0.003)、发热少于TRPB组(P=0.047)、疼痛重于TRPB组(P=0.005),以上差异具有统计学意义。结论超声引导下经会阴前列腺穿刺术具有和经直肠前列腺穿刺术相似的诊断效能,可减少穿刺点出血和发热的发生,局部麻醉辅以全身麻醉便于该技术开展和推广。

关键词: 前列腺穿刺术, 会阴, 直肠

Abstract: Objective To compare the diagnostic efficacy and safety of transperineal prostate biopsy (TPPB) and transrectal prostate biopsy (TRPB) in prostate cancer. Methods From January 2018 to January 2020, 237 patients received prostate biopsy under local anaesthesia in Beijing Chaoyang Hosipital, Capital Medical University, including TRPB applied to 185 patients between January 2018 and June 2019 and TPPB to 52 cases between July 2019 and January 2020. Results The perioperative information was analyzed and compared. There was no statistically significant differences between the two groups in preoperative parameters, including age [(68.2±9.2) years vs (69.7±8.1) years, P=0.331], body mass index (BMI) [(24.7±3.3) kg/m² vs (24.7±3.1) kg/m², P=0.924], Charlson comorbidity index (CCI) (2.7±1.7 vs 2.8±1.1, P=0.744), prostate volume [(59.5±32.0) cm³ vs (65.9±28.7) cm³, P=0.512)], and International Prostate Symptom Score (IPSS) (10.3±4.7 vs 10.2±5.0, P=0.960). No significant differences was found between the two groups in preoperative laboratory results (P>0.05).Fifty-two patients of TPPB and 185 patients of TRPB was successfully implemented, with 33and 145 cases of complications in Grade 1 of Clavien-Dindo in postoperative 7 days. There were no statistically significant differences between the two groups in cores, positive cores, pathology positive, Gleason Score, clinically significant prostate cancer (CsPCa), hematuria, lower urinary tract symptoms (LUTs), hematospermia or other Clavien-Dindo1 complications. The TPPB group acquired more operative time (P<0.001), less bleeding at puncture points (P=0.003), fewer fever (P=0.047), and more cases of Visual Analogue Scale/Score(VAS)≥4(P=0.005) with statistical significance. Conclusion Compared with TRPB, TPPB possesses similar diagnostic efficacy under local anaesthesia or general anesthesia if needed, with decreased bleeding at puncture points and the rate of fever.

Key words: prostate biopsy, perineal, rectum

中图分类号:

刘赛, 王明帅, 曹文, 谢大炜, 牛亦农, 宋黎明, 张小东, 王建文. 经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的对比分析[J]. 首都医科大学学报, 2021, 42(3): 470-474.

Liu Sai, Wang Mingshuai, Cao Wen, Xie Dawei, Niu Yinong, Song Liming, Zhang Xiaodong, Wang Jianwen. Comparison between ultrasound guided transperineal and transrectal prostate biopsy in the diagnosis of prostate cancer[J]. Journal of Capital Medical University, 2021, 42(3): 470-474.

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