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目的探讨超声引导下经直肠饱和穿刺在临床疑诊为前列腺癌但首次活检阴性患者中的诊断价值,评价其有效性和安全性。方法 将120例因前列腺特异抗原(PSA)和(或)直肠指检异常而接受前列腺12针穿刺活检、且结果为阴性的患者纳入研究,随机分为扩大穿刺组(采用12针扩大穿刺法)和饱和穿刺组(采用24针饱和穿刺法),行超声引导下经直肠重复穿刺活检。对两组患者均行前列腺周围神经阻滞术,穿刺活检过程中观察患者情况,并采用视觉模拟评分(VAS)评估疼痛程度。结果 两组患者年龄、总PSA水平、PSA密度、前列腺总体积及移行区体积、首次穿刺病理、直肠指诊情况、穿刺活检过程中患者VAS和术后并发症差异均无统计学意义(P均>0.05)。饱和穿刺组前列腺体积>60ml者的穿刺阳性率高于扩大穿刺组(P=0.033),其穿刺总体阳性率亦高于扩大穿刺组(31.67%vs 15.00%,P=0.031)。结论 经直肠饱和穿刺活检可以提高临床疑诊前列腺癌但首次活检阴性者的前列腺癌检出率,且不增加并发症发生率。
Objective To investigate the diagnostic value of ultrasound-guided transnasal saturable puncture in patients with clinically suspected prostate cancer but with negative first biopsy, and evaluate its effectiveness and safety. Methods A total of 120 patients with negative PSA and prostate PSA due to PSA and / or abnormality of the digital rectal examination were enrolled in the study. Patients were randomly divided into enlarged puncture group (12-needle extended puncture) And saturated puncture group (using 24-needle saturated puncture), ultrasound-guided transrectal puncture biopsy. Peripheral nerve block was performed on both groups. The patients were observed during the biopsy and visual analogue scale (VAS) was used to evaluate the degree of pain. Results There was no significant difference in VAS and postoperative complications between the two groups in age, total PSA level, PSA density, total prostate volume, volume of transitional zone, primary puncture pathology, digital rectal examination, and postoperative biopsy > 0.05). The positive rate of puncture in the group of saturated puncture group with volume> 60ml was higher than that of the expanded puncture group (P = 0.033). The overall positive rate of puncture was also higher than that of the expanded puncture group (31.67% vs 15.00%, P = 0.031). Conclusions Transrectal needle biopsy can improve the detection rate of prostate cancer in patients with clinically suspected prostate cancer but not in first biopsy, and does not increase the incidence of complications.