前列腺穿刺活检阳性率相关影响因素分析

发布时间：2018-04-18 06:59

本文选题：前列腺癌 + 诊断价值　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:探讨影响前列腺穿刺检出率的相关影响因素,并评估其对前列腺癌的临床诊断效能。分析探讨血清PSA系列指标、直肠指诊、经直肠超声、多参数MRI等前列腺癌早期检查措施对临床前列腺穿刺的指导价值。对比分析经直肠与经会阴不同入路穿刺方式对前列腺癌检出率及术后并发症的影响。方法:收集2005年至2015年10年间于天津医科大学第二医院行TRUS引导下前列腺穿刺活检术病例的详细临床资料,主要包括穿刺前血清PSA系列值、前列腺体积、直肠指诊及TRUS和多参数MRI、穿刺方式、穿刺术后病理等,比较相关检查方式穿刺的敏感度、特异度及阳性率等相关指标,并评估对前列腺癌的早期诊断效能。重点探讨当血清PSA值介于4-10ng/ml时,PSAD对前列腺癌的早期诊断价值,更好的指导临床工作,进一步提高前列腺癌早期诊断阳性率,避免误诊、漏诊。按穿刺方式分为经直肠前列腺穿刺组及经会阴模板定位前列腺穿刺活检组2组,通过相关统计学方法比较两种穿刺方式在穿刺阳性率、术后并发症发生率等方面的差异。最终通过对相关指标、检查方式及穿刺方式的分析,为临床穿刺提供重要参考价值,进一步提高穿刺的阳性率,避免不必要的穿刺行为,减轻患者及家庭心理、医疗负担。结果:DRE诊断早期前列腺癌的敏感性及特异度分别为40.2%及79.6%。经直肠超声检查诊断早期前列腺癌的敏感性及特异度分别为61.5%及68.4%。mp MRI诊断早期前列腺癌的敏感性及特异度分别为83.7%及79.3%。当TPSA介于4-10ng/ml时,前列腺穿刺的阳性率为21.2%。此时,良性增生组及前列腺恶性肿瘤组的PSAD及FPSA/TPSA相比,均具有显著性差异。TPSA、FPSA/TPSA及PSAD三者中,PSAD在ROC曲线下的面积最大,提示当TPSA介于4-10ng/ml时,PSAD具较高的诊断价值,且高于FPSA/TPSA诊断价值。经直肠前列腺穿刺阳性率约为35%,经会阴模板定位前列腺穿刺术阳性率约为43.1%,后者明显高于前者。两种穿刺方式术后均存在不同程度的并发症,同一种并发症在两种穿刺途径中的发生率不同。经直肠途径穿刺术后血便、感染的发生率明显高于经会阴组,而经会阴穿刺术后会阴部出血肿痛的发生率明显高于经直肠组。结论:1.前列腺癌的发病与年龄相关,临床发现的前列腺癌患者年龄多在50岁以上,且随年龄增长,发病率有逐渐上升趋势,因此,推荐50岁以上男性常规行血清学PSA及泌尿系彩超检查,定期筛查前列腺癌。2.血清学PSA检测仍为目前应用最为广泛的前列腺癌早期筛查指标,具有较高的前列腺癌诊断效能。但也存在特异性及敏感度不足等问题,联合检测PSAD、FPSA/TPSA等指标,可进一步提高前列腺癌诊断阳性率,避免误诊漏诊。尤其当PSA介于4-10ng/ml时,PSAD的前列腺癌早期诊断效能较高。DRE及TRUS、多参数MRI等影像学检查指标对提高前列腺癌诊断阳性率均有一定促进作用,单独应用时往往存在敏感性不足等问题,多种筛查手段联合使用往往能取得良好的诊断效果。3.当血清PSA位于诊断灰区时,经会阴模板定位前列腺穿刺阳性率明显高于经直肠穿刺路径,术后并发症的发生率因并发症类型不同而异。考虑与前者穿刺针数较多、模板定位引导下穿刺部位更为精确等有关。经直肠组术后血便、感染等并发症的发生率明显高于经会阴组;而血尿、会阴部出血、肿痛的发生率明显低于经会阴穿刺组。但后者也存在操作复杂、耗时长、留院时间长、麻醉时间长及需要特殊设备、不易推广等不足之处。
[Abstract]:Objective: To study the influencing factors for the detection rate of prostate biopsy, and to evaluate the clinical efficacy of prostate cancer diagnosis. Analysis of serum PSA index, rectal examination and transrectal ultrasound, many parameters such as MRI prostate cancer early detection measures puncture guiding value in clinical prostate. Comparative analysis of the influence of complications of transrectal different approaches and transperineal puncture on the prostate cancer detection rate and postoperative. Methods: from 2005 to 2015 10 years in Second Hospital Affiliated to Tianjin Medical University underwent TRUS guided prostate biopsy cases detailed clinical data, including before puncture PSA serum values, prostate volume, rectal examination and TRUS and multi parameter MRI puncture, puncture and postoperative pathology, comparing the relevant inspection methods puncture sensitivity, specificity and positive rate of relevant indicators, and early evaluation of prostate cancer Focus on the diagnostic efficiency. When the serum PSA value 4-10ng/ml, PSAD value in early diagnosis of prostate cancer, and guide clinical work better, to further improve the positive rate of prostate cancer, early diagnosis and avoid misdiagnosis, missed diagnosis. By puncture divided into transrectal puncture group and transperineal prostate biopsy template positioning group 2 through the relevant statistical methods, comparison of two kinds of puncture in the positive rate of puncture, postoperative complication rate. Finally through the examination and analysis of relevant indicators, puncture way, provide an important reference for clinical value to further improve the positive rate of puncture, puncture, puncture and avoid unnecessary, and relieve patients family psychology, medical burden. Results: DRE diagnosis of early prostate cancer susceptibility and specificity were 40.2% and 79.6%. by transrectal ultrasonography in the diagnosis of early prostate cancer The sensitivity and specificity were 61.5% and 68.4%.mp sensitivity of MRI in diagnosis of early prostate cancer and specificity were 83.7% and 79.3%. when TPSA is 4-10ng/ml, the positive rate of prostate biopsy for 21.2%. at this time, compared with benign hyperplasia and prostate malignant tumor group PSAD and FPSA/ TPSA, have significant difference between FPSA/TPSA and.TPSA. PSAD three, PSAD in the area under the ROC curve, suggesting that when TPSA is 4-10ng/ml, PSAD has a higher diagnostic value, and higher than the diagnostic value of FPSA/TPSA. The positive rate of rectum prostate biopsy is about 35%, the positive rate of prostate puncture perineal template location is about 43.1%, which was significantly higher than that of the former two. Puncture ways have different degrees of postoperative complications, with a complication in two kinds of puncture in different incidence. Transrectal puncture postoperative stool, infection incidence was significantly Higher than that of transperineal group and transperineal puncture postoperative perineal swelling bleeding incidence was significantly higher than the transrectal group. Conclusion: 1. the incidence of prostate cancer is correlated with age, age of patients with prostate cancer clinically found in more than 50 years old, and with age, the incidence rate has gradually increased, therefore, recommended men over the age of 50 routine serological PSA and urinary tract ultrasound examination, regular screening for prostate cancer.2. PSA serological testing is still the most widely used index of early screening for prostate cancer, the diagnosis of prostate cancer with high efficiency. But it also has the specificity and sensitivity of the problems, combined detection of PSAD, FPSA/TPSA and other indicators. Can further improve the positive rate of prostate cancer diagnosis, to avoid misdiagnosis. Especially when PSA is 4-10ng/ml, PSAD in the early diagnosis of prostate cancer and the high efficiency.DRE TRUS, MRI and other multi parameter imaging means The subject of improving the positive rate has a certain role in diagnosis of prostate cancer, there is often the problem of insufficient sensitivity when used alone and combined use of multiple screening measures can get good results when the serum.3. in the diagnosis of PSA in diagnostic gray zone, the positive rate of perineal prostate biopsy template positioning was significantly higher than that of transrectal puncture path, postoperative complications the rate for complications varied with different types. And considering the former needle number of template guided puncture is more accurate and so on. Transrectal postoperative blood, complications such as infection rate was significantly higher than that of transperineal group; and hematuria, perineal bleeding, swelling and pain were significantly lower than the transperineal puncture group. But the latter has complicated operation, long time, hospital stay time, anesthesia time is long and the need of special equipment, not easy to promote such deficiencies.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.25

【参考文献】