不同血清PSA水平的前列腺穿刺阳性率及Gleason评分的关系比较

发布时间：2018-08-18 12:06

【摘要】：目的:比较不同血清PSA水平的前列腺穿刺阳性率及Gleason评分,探讨血清PSA与前列腺穿刺阳性率及Gleason评分的关系。方法:收集2014年9月到2015年12月在吉林大学中日联谊医院就诊的122例疑似前列腺癌患者的完整临床资料,年龄范围49-91岁,平均71.2±5.6岁,所有患者均行直肠指诊、血清PSA、经直肠前列腺彩超等检查疑似前列腺癌,行超声引导下前列腺穿刺活检,其中55例行术中丁卡因胶浆局部浸润麻醉,67例术中肛内注射5ml碘伏,通过记录术后VAS评分的方法评估局部浸润麻醉对于疼痛的改善。穿刺病理结果回报确诊为前列腺癌的患者共55例,根据血清PSA值的不同将其分为四组:A组(PSA4ng/ml)、B组(4ng/mlPSA10ng/ml)、C组(10ng/mlPSA20ng/ml)及D组(PSA≥20ng/ml),统计各组前列腺穿刺阳性率、Gleason评分,通过统计学比较不同血清PSA水平的前列腺穿刺阳性率及Gleason评分之间的关系,其中血清PSA介于4-20ng/ml之间以PSAD=0.19ng/(ml*cm3)为临界值分为两组,比较两组之间前列腺穿刺阳性率的关系。结果:122例患者均顺利完成彩超引导下前列腺10针系统穿刺。穿刺活检术后病理确诊为前列腺癌者共有55人(45.1%),前列腺增生者48例,前列腺炎者5例,前列腺上皮内瘤12例,肉芽肿性前列腺炎1例,结核1例。Gleason评分≤7分共22例(40.0%)Gleason评分≥8分的共33例(60.0%)。1.A组共3例均因经直肠彩超等提示异常回声行前列腺穿刺活检,确诊为前列腺癌的1例,Gleason评分为6分。2.B组(4ng/mlPSA10ng/ml)、C组(10ng/mlPSA20ng/ml)与D组(PSA≥20ng/ml)的前列腺癌穿刺阳性率分别为17.4%(4/23)、31.7%(13/41)、67.3%(37/55),两两之间行卡方检验,B组与C组差异无统计学意义(p0.05),B组与D组差异具有统计学意义(p0.05),C组与D组差异亦具有统计学意义(p0.05)。3.B、C两组患者,以PSA密度(PSAD)=0.195ng/(ml*cm3)为临界值分为两组,PSAD0.19ng/(ml*cm3)组与PSAD0.19ng/(ml*cm3)组的前列腺癌穿刺阳性率分别为10.7%(3/28)、38.9%(14/36),两组之间前列腺穿刺阳性率具有统计学意义(p0.05)。4.B组(4ng/mlPSA10ng/ml)前列腺癌患者共4例,其Gleason评分均≤7分、C组(10ng/mlPSA20ng/ml)与D组(PSA≥20ng/ml)的Gleason评分≥8分的患者分别占38.5%(5/13)、75.7%(28/37),两两之间行卡方检验,B组与C组差异无统计学意义(p0.05),B组与D组差异具有统计学意义(p0.05),C组与D组差异亦具有统计学意义(p0.05)。5.丁卡因胶浆组术后VAS评分为2.109±0.685分,对照组术后VAS评分为4.179±0.851分,差异具有统计学意义(p0.05)。结论:1.前列腺癌穿刺阳性、Gleason评分与血清PSA值呈正相关关系,随者血清PSA值的升高,前列腺穿刺阳性率升高,Gleason评分越高。2.当PSA位于4-20ng/ml时,以PSAD=0.19ng/(ml*cm3)为临界值可以提高前列腺癌的穿刺阳性率。3.丁卡因胶浆局部麻醉可以降低前列腺穿刺活检中的疼痛,是一种安全、有效的操作方法,值得推广应用。
[Abstract]:Objective: to compare the positive rate and Gleason score of prostate puncture with different serum PSA levels, and to explore the relationship between serum PSA and prostate puncture positive rate and Gleason score. Methods: the complete clinical data of 122 patients with suspected prostate cancer from September 2014 to December 2015 were collected. The age range was 49-91 years (mean 71.2 卤5.6 years). Serum PSA, transrectal prostate color ultrasound and other suspected prostate cancer were examined by ultrasound guided prostatic biopsy. 55 cases were given intraoperative intraanal injection of 5ml iodophor in 67 cases of local infiltration anesthesia with tetracaine glue. The effect of local invasive anesthesia on pain was evaluated by recording the postoperative VAS score. A total of 55 patients with prostate cancer confirmed by puncture pathological results were divided into four groups according to the different serum PSA values: group B (PSA4ng/ml), group C (10ng/mlPSA20ng/ml) and group D (PSA 鈮，

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