超声造影精准穿刺在经直肠前列腺穿刺活检中的应用

何佳; 刘宁; 于田强; 时开元; 段跃

doi:10.16766/j.cnki.issn.1674-4152.003258

超声造影精准穿刺在经直肠前列腺穿刺活检中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003258

何佳^1, ,,
刘宁²,
于田强¹,
时开元³,
段跃⁴

1.
浙江省荣军医院泌尿外科，浙江嘉兴 314000
2.
浙江省荣军医院超声介入科
3.
浙江省肿瘤医院超声介入科，浙江杭州 310022
4.
浙江中医药大学附属第二医院泌尿外科，浙江杭州 310005

基金项目:

浙江省基础公益研究计划项目 LY20H270003

嘉兴市科技计划项目 2020AD30003

详细信息

通讯作者:
何佳，E-mail：zjrjyyhj@163.com

中图分类号: R446.8R737.25
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- 文章访问数: 138
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- 被引次数: 0
出版历程
- 收稿日期: 2023-06-06
- 网络出版日期: 2024-01-13

Application of contrast-enhanced ultrasound precise puncture in transrectal prostate biopsy

1.
Urology Department, Rongjun Hospital of Zhejiang Province, Jiaxing, Zhejiang 314000, China

摘要

摘要: 目的研究超声造影精准穿刺在经直肠前列腺穿刺活检中的应用效果, 旨在提高穿刺阳性率、减轻患者痛苦, 为临床诊治提供依据。方法选择2019年7月-2022年12月浙江省荣军医院收治的150例前列腺特异性抗原(PSA)升高、前列腺结节患者, 按照随机数表法分为对照组(75例)与观察组(75例), 2组均行经直肠前列腺穿刺活检, 对照组于常规超声引导下穿刺, 观察组于超声造影下精准穿刺。每组按PSA值分4个区间, 第一组: 4 ng/mL < PSA≤10 ng/mL; 第二组: 10 ng/mL < PSA≤20 ng/mL; 第三组: 20 ng/mL < PSA≤40 ng/mL; 第四组: PSA>40 ng/mL。比较2组患者相关指标、不良反应发生情况, 以及4个区间穿刺活检病理的恶性检出率。结果观察组穿刺针数与对照组相近(P>0.05);阳性针数[(1.84±0.52)针]、Gleason评分[(7.25±1.22)分]高于对照组[(1.56±0.41)针、(6.32±1.06)分, 均P < 0.05]。观察组不良反应发生率(9.33%, 7/75)低于对照组(46.67%, 35/75, P < 0.05)。观察组的恶性检出率(52.00%, 39/75)高于对照组(34.67%, 26/75, P < 0.05)。2组不同PSA区间穿刺活检病理的恶性检出率比较差异有统计学意义(P < 0.05)。结论超声造影精准穿刺在经直肠前列腺穿刺活检中应用效果较好, 可提高穿刺阳性率与前列腺癌检出率, 且能减少不良反应, 值得推广。
- 超声造影 /
- 精准穿刺 /
- 经直肠前列腺穿刺活检 /
- 前列腺癌 /
- 诊断
Abstract: Objective To study the application effect of contrast-enhanced ultrasound precise puncture in transrectal prostate biopsy, aiming to improve the puncture positive rate, reduce patient pain, and provide a basis for clinical diagnosis and treatment. Methods A total of 150 patients with elevated prostate specific antigen (PSA) and prostate nodules admitted to the Rongjun Hospital of Zhejiang Province from July 2019 to December 2022 were selected and divided into control group (75 cases) and observation group (75 cases) according to the random number table method.Both groups underwent transrectal prostate biopsy, the control group undergoing routine ultrasound guided puncture, while the observation group undergoing precise ultrasound contrast-enhanced puncture.Each group was divided into four intervals based on PSA values, the first group: 4 ng/mL < PSA≤ 10 ng/mL; the second group: 10 ng/mL < PSA≤20 ng/mL; the third group: 20 ng/mL < PSA≤40 ng/mL; the fourth group: PSA>40 ng/mL.The related indicators (number of puncture needles, number of positive needles, Gleason score), incidence of adverse reactions (slight hematuria, fever, rectal bleeding, urinary retention, dysuria), and malignant detection rate of biopsy pathology in four regions were compared between the two groups. Results The number of puncture needles in the observation group was similar to that in the control group (P>0.05).The number of positive needles[(1.84±0.52) needles]and Gleason score[(7.25±1.22) points]were higher than those in the control group[(1.56±0.41) needles, (6.32±1.06) points, both P < 0.05].The incidence of adverse reactions in the observation group (9.33%, 7/75) was lower than that in the control group (46.67%, 35/75, P < 0.05).The malignant detection rate in the observation group (52.00%, 39/75) was higher than that in the control group (34.67%, 26/75, P < 0.05).The difference in malignant detection rate of puncture biopsy pathology between different zones in the 2 groups was statistically significant (P < 0.05). Conclusion The application of contrast-enhanced ultrasound precise puncture in transrectal prostate biopsy has a good effect, can improve the positive rate of puncture and the detection rate of prostate cancer, and can reduce adverse reactions, which is worthy of application.
- Contrast-enhanced ultrasound /
- Accurate puncture /
- Transrectal prostate biopsy /
- Prostate cancer /
- Diagnosis

HTML全文

表 1 2组经直肠前列腺穿刺活检患者穿刺相关指标比较(x±s)

Table 1. Comparison of relevant indexes between two groups of patients with transrectal prostate biopsy (x±s)

组别	例数	穿刺针数 (针)	阳性针数 (针)	Gleason 评分(分)
对照组	75	12.14±1.78	1.56±0.41	6.32±1.06
观察组	75	12.59±1.70	1.84±0.52	7.25±1.22
t值		1.583	3.662	4.983
P值		0.115	＜0.001	＜0.001

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表 2 2组经直肠前列腺穿刺活检患者不良反应发生情况比较

Table 2. Comparison of the occurrence of adverse reactions between two groups of patients with transrectal prostate biopsy

组别	例数	轻微血尿 (例)	发热 (例)	直肠出血 (例)	尿潴留 (例)	排尿困难 (例)	总发生 [例(%)]
对照组	75	21	4	4	3	3	35(46.67)
观察组	75	4	1	1	1	0	7(9.33)
注：2组不良反应总发生率比较，χ²=25.926，P＜0.001。

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表 3 2组经直肠前列腺穿刺活检患者恶性检出率比较

Table 3. Comparison of malignant detection rates between two groups of patients with transrectal prostate biopsy

组别	例数	恶性例数	恶性检出率 (%)	组别	例数	恶性例数	恶性检出率 (%)
对照组	75	26	34.67	观察组	75	39	52.00
第一组	36	9	25.00	第一组	35	14	40.00
第二组	21	7	33.33	第二组	22	11	50.00
第三组	12	6	50.00	第三组	11	8	72.73
第四组	6	4	66.67	第四组	7	6	85.71
Z值			7.256	Z值			11.533
P值			＜0.001	P值			＜0.001
注：2组恶性检出率比较，χ²=4.588，P=0.032。

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参考文献(20)

[1]	王超, 梅志杰, 曹振学, 等. 前列腺癌中miR-140-5p靶向YES1抑制细胞增殖和迁移的作用研究[J]. 中华全科医学, 2021, 19(5): 731-735. doi: 10.16766/j.cnki.issn.1674-4152.001903 WANG C, MEI Z J, CAO Z X, et al. Study on the inhibitory effect of miR-140-5p targeting YES1 on cell proliferation and migration in prostate cancer[J]. Chinese Journal of General Medicine, 2021, 19(5): 731-735. doi: 10.16766/j.cnki.issn.1674-4152.001903
[2]	方超, 黄山, 石敏捷, 等. 前列腺穿刺活检在超声造影阳性区减针的初步研究[J]. 临床与病理杂志, 2022, 42(5): 1173-1178. FANG C, HUANG S, SHI M J, et al. Preliminary study on needle reduction of prostate biopsy in the positive area of contrast-enhanced ultrasound[J]. Journal of Clinical and Pathology, 2022, 42(5): 1173-1178.
[3]	姜脉涛, 靳艳萍, 王秀云, 等. 系统活检联合超声造影及弹性成像靶向活检在前列腺活检中的应用价值[J]. 现代生物医学进展, 2022, 22(19): 3719-3723. JIANG M T, JIN Y P, WANG X Y, et al. The application value of systematic biopsy combined with contrast-enhanced ultrasound and elastography targeted biopsy in prostate biopsy[J]. Modern Biomedical Progress, 2022, 22(19): 3719-3723.
[4]	金阳丽, 蒋天安. 不同影像引导方式下前列腺穿刺活检的比较分析[J]. 中国超声医学杂志, 2022, 38(10): 1165-1169. JIN Y L, JIANG T A. Comparative analysis of prostate biopsy under different imaging guidance methods[J]. Chinese Journal of Ultrasound Medicine, 2022, 38(10): 1165-1169.
[5]	高泳, 陈圆圆, 韦丽艳, 等. 前列腺癌超声造影、活检受侵范围与病理新分级分组的相关性[J]. 中国医学影像学杂志, 2022, 30(3): 272-276. GAO Y, CHEN Y Y, WEI L Y, et al. The correlation between the invasion range of prostate cancer contrast-enhanced ultrasound, biopsy, and new pathological grading grouping[J]. Chinese Journal of Medical Imaging, 2022, 30(3): 272-276.
[6]	张宇, 汪良, 宋亚荣, 等. 直肠超声引导下认知融合磁共振经会阴途径前列腺穿刺活检的个人学习曲线研究[J]. 临床泌尿外科杂志, 2022, 37(5): 354-358. ZHANG Y, WANG L, SONG Y R, et al. A study on the personal learning curve of rectal ultrasound guided cognitive fusion magnetic resonance transperineal prostate biopsy[J]. Journal of Clinical Urology, 2022, 37(5): 354-358.
[7]	李渝, 罗季平, 但思宇, 等. 经直肠常规超声联合超声造影在前列腺良恶性病灶鉴别诊断中的应用[J]. 中国超声医学杂志, 2023, 39(3): 287-291. LI Y, LUO J P, DAN S Y, et al. Application of transrectal conventional ultrasound combined with contrast-enhanced ultrasound in the differential diagnosis of benign and malignant prostate lesions[J]. Chinese Journal of Ultrasound Medicine, 2023, 39(3): 287-291.
[8]	蔡浪, 思雨, 吴小燕. 比较直肠超声引导下经会阴与经直肠前列腺穿刺活检的临床应用效果[J]. 检验医学与临床, 2022, 19(7): 948-950. CAI L, SI Y, WU X Y. Comparison of clinical application effects of transvaginal and transrectal prostate biopsy guided by rectal ultrasound[J]. Journal of Laboratory Medicine and Clinical Medicine, 2022, 19(7): 948-950.
[9]	刘赛, 王明帅, 曹文, 等. 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. doi: 10.3969/j.issn.1006-7795.2021.03.022] LIU S, WANG M S, CAO W, et al. Comparative analysis of transperineal and rectal prostate biopsy in the diagnosis of prostate cancer[J]. Journal of Capital Medical University, 2021, 42(3): 470-474. doi: 10.3969/j.issn.1006-7795.2021.03.022]
[10]	盛烨钦, 徐泽坤, 王超, 等. 超声造影靶向穿刺与磁共振超声融合穿刺在前列腺癌诊断上的比较[J]. 中国超声医学杂志, 2022, 38(9): 1054-1057. doi: 10.3969/j.issn.1002-0101.2022.09.027 SHENG Y Q, XU Z K, WANG C, et al. Comparison of contrast-enhanced ultrasound targeted puncture and magnetic resonance ultrasound fusion puncture in the diagnosis of prostate cancer[J]. Chinese Journal of Ultrasound Medicine, 2022, 38(9): 1054-1057. doi: 10.3969/j.issn.1002-0101.2022.09.027
[11]	刘水澎, 王艺桦, 阚艳敏, 等. 剪切波弹性成像联合超声造影在良恶性前列腺结节鉴别诊断中的应用价值[J]. 广西医学, 2021, 43(22): 2675-2677, 2693. LIU S P, WANG Y H, KAN Y M, et al. The application value of shear wave elastography combined with contrast-enhanced ultrasound in the differential diagnosis of benign and malignant prostate nodules[J]. Guangxi Medical Journal, 2021, 43(22): 2675-2677, 2693.
[12]	吴国柱, 马可为, 红华, 等. 超声造影对前列腺脓肿的诊断价值[J]. 中国超声医学杂志, 2021, 37(9): 1073-1076. WU G Z, MA K W, HONG H, et al. The diagnostic value of contrast-enhanced ultrasound in prostate abscess[J]. Chinese Journal of Ultrasound Medicine, 2021, 37(9): 1073-1076.
[13]	崔凌煦, 红华, 梁丹艳, 等. 经直肠超声造影联合血清外泌体对早期前列腺癌的诊断价值[J]. 中华实用诊断与治疗杂志, 2022, 36(11): 1145-1148. CUI L X, HONG H, LIANG D Y, et al. The diagnostic value of transrectal contrast-enhanced ultrasound combined with serum exosomes for early prostate cancer[J]. Chinese Journal of Practical Diagnosis and Treatment, 2022, 36(11): 1145-1148.
[14]	刘鸿翔, 刘肇华, 刘锡海, 等. 经直肠超声弹性成像辅助下前列腺穿刺活检用于前列腺癌诊断的价值[J]. 海南医学, 2021, 32(20): 2663-2666. LIU H X, LIU Z H, LIU X H, et al. The value of transrectal ultrasound elastography assisted prostate biopsy for the diagnosis of prostate cancer[J]. Hainan Medical Journal, 2021, 32(20): 2663-2666.
[15]	白松, 吴斌. 在磁共振阴性的患者中经直肠超声引导下前列腺穿刺活检术诊断前列腺癌的预测模型[J]. 中国男科学杂志, 2021, 35(2): 12-18, 23. BAI S, WU B. A predictive model for transrectal ultrasound guided prostate biopsy in the diagnosis of prostate cancer in patients with negative magnetic resonance imaging[J]. Chinese Journal of Andrology, 2021, 35(2): 12-18, 23.
[16]	聂军, 赵友, 罗卫平, 等. 多参数磁共振成像: 经直肠超声认知融合引导下经会阴前列腺靶向穿刺活检在前列腺癌诊断中的应用[J]. 江苏医药, 2022, 48(11): 1145-1148. NIE J, ZHAO Y, LUO W P, et al. Application of transperineal targeted prostate biopsy guided by multi-parameter magnetic resonance imaging transrectal ultrasound cognitive fusion in the diagnosis of prostate cancer[J]. Jiangsu Medical Journal, 2022, 48(11): 1145-1148.
[17]	赵云歆, 孙剑, 王晓莲, 等. 经直肠超声造影成像联合磁共振对前列腺癌的早期诊断价值[J]. 中国CT和MRI杂志, 2021, 19(8): 120-122, 128. ZHAO Y X, SUN J, WANG X L, et al. The early diagnostic value of transrectal contrast-enhanced ultrasound imaging combined with magnetic resonance imaging for prostate cancer[J]. Chinese Journal of CT and MRI, 2021, 19(8): 120-122, 128.
[18]	汪蕾, 肖峻, 陶陶, 等. 双参数磁共振成像: 经直肠超声引导靶向穿刺与前列腺特异性抗原或前列腺特异性抗原密度组合对前列腺癌诊断价值的研究[J]. 中国临床保健杂志, 2022, 25(3): 402-406. WANG L, XIAO J, TAO T, et al. Study on the diagnostic value of dual parameter magnetic resonance imaging transrectal ultrasound guided targeted puncture combined with prostate specific antigen or prostate specific antigen density for prostate cancer[J]. Chinese Journal of Clinical Health, 2022, 25(3): 402-406.
[19]	吴汉潮, 张雄伟, 王强, 等. MRI与经直肠超声引导下前列腺穿刺活检术对不同PSA水平前列腺癌患者的诊断效能比较[J]. 河北医药, 2021, 43(19): 2958-2961. WU H C, ZHANG X W, WANG Q, et al. Comparison of diagnostic efficacy between MRI and transrectal ultrasound guided prostate biopsy for prostate cancer patients with different PSA levels[J]. Hebei Medical Journal, 2021, 43(19): 2958-2961.
[20]	贺修宝, 李灿, 胡小梅. 经直肠超声造影、血清前列腺特异性抗原检测在前列腺癌穿刺活检诊断中的应用[J]. 中国性科学, 2022, 31(2): 9-12. HE X B, LI C, HU X M. Application of transrectal contrast-enhanced ultrasound and serum prostate specific antigen detection in prostate cancer biopsy diagnosis[J]. Chinese Journal of Sexual Sciences, 2022, 31(2): 9-12.