TRUS及超声造影联合MRI引导前列腺靶向穿刺的临床研究

发布时间：2018-05-05 09:19

本文选题：前列腺癌 + 经直肠超声　；参考：《华北理工大学》2017年硕士论文

【摘要】：目的探讨经直肠超声及超声造影联合MRI引导前列腺靶向穿刺的临床应用价值。方法选取2014年1月至2016年5月唐山工人医院行前列腺穿刺活检的、并经手术病理证实的患者187例进行回顾性分析,其中前列腺10点系统穿刺患者102例,靶向穿刺的患者85例,比较两组穿刺前列腺癌的检出率、穿刺针数及前列腺癌Gleason评分情况、穿刺后并发症、两组前列腺癌检出效能、不同PSA分组时两种方法的前列腺癌检出率比较,看两组差异是否有统计学意义。结果1靶向穿刺前列腺癌的检出率为62.35%,系统穿刺检出率为43.14%,术后阳性符合率靶向组为89.83%,系统穿刺组为70.97%,靶向组高于系统组,差异有统计学意义(P0.05)。2系统穿刺共穿刺1020针,每人穿刺10针,靶向穿刺共穿刺612针,平均每人穿刺7.2针,单针阳性率靶向组为26.31%,系统组为12.94%,可以看出靶向穿刺减少了穿刺针数,提高了单针检出前列腺癌的阳性率,差异有统计学意义(P0.05)。3穿刺及术后病理结果:靶向组穿刺病理结果前列腺癌Gleason评分≥7分的为33例,手术后病理Gleason评分≥7分的为45例;系统组穿刺病理Gleason评分≥7分20例,手术后病理Gleason评分≥7分47例,穿刺后高分率分别为62.26%、45.45%,与术后病理中高分的符合率分别为73.33%、42.55%,比较两组穿刺的高分符合率情况,结果显示靶向组的符合率高于系统穿刺组,差异有统计学意义(P0.05)。4靶向组检出前列腺癌的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为89.83%、84.62%、92.98%、78.57%、88.24%;系统穿刺组分别为70.97%、77.50%、83.02%、63.27%、73.53%,比较两组的敏感性、特异性、阳性预测值、阴性预测值和准确性,结果显示靶向组的敏感性和准确性高于系统组,差异有统计学意义(P0.05);靶向组的特异性、阳性预测值、阴性预测值高于系统组,但差异无统计学意义(P0.05)。5两组前列腺穿刺活检患者中靶向穿刺中出现血尿者8例,血便者7例,血精2例,低热1例;系统穿刺中血尿21例,血便15例,血精5例,低热3例,尿潴留2例,结果显示系统穿刺组的各种并发症发生率均高于靶向穿刺组,其中血尿发生率的差异经比较有统计学意义(P0.05),靶向穿刺组的并发症合计率低于系统穿刺组,差异有统计学意义(P0.05)。6根据PSA进行分层,靶向穿刺和系统穿刺阳性和阴性结果显示,在PSA水平低于10ng/ml的患者中,靶向穿刺和系统穿刺PCa检出率分别为31.25%和19.23%;在PSA水平为10~20ng/ml的患者中,靶向穿刺和系统穿刺PCa检出率分别为42.86%和32.00%;在PSA高于20ng/ml的患者中,靶向穿刺和系统穿刺PCa检出率分别为81.25%和58.82%;靶向穿刺的PCa检出率在不同PSA分层中均高于系统穿刺,比较结果显示在PSA高于20ng/ml的患者中,靶向穿刺的PCa检出率高于系统穿刺,有统计学意义(P0.05)。结论TRUS及超声造影联合MRI引导前列腺靶向穿刺能明显提高前列腺癌的检出率,并且减少了穿刺针数,能提高较高Gleason评分前列腺癌的检出率,同时减少了穿刺术后并发症,对前列腺癌的检出有较高的敏感性,有较高的临床应用价值。
[Abstract]:Objective to explore the clinical application value of transrectal ultrasound and ultrasound contrast MRI guided prostate targeted puncture. Methods 187 cases of prostate biopsy in Tangshan workers' hospital from January 2014 to May 2016 were selected and the patients confirmed by operation and pathology were analyzed retrospectively, of which 102 cases of prostate 10 point puncture patients were targeted and targeted. 85 cases of pricking patients were compared, compared with the two groups, the detection rate of prostate cancer, the number of puncture needle and the Gleason score of prostate cancer, the complications after the puncture, the detection efficiency of the prostate cancer in the two groups, and the comparison of the two methods of prostate cancer detection in the different PSA groups, the difference between the two groups was statistically significant. Results the detection of the 1 target to the prostate cancer was detected. The rate was 62.35%, the detection rate of the system puncture was 43.14%, the positive rate in the target group was 89.83%, the system puncture group was 70.97%, the target group was 70.97% and the target group was higher than the system group. The difference was statistically significant (P0.05).2 system puncture 1020 needles, 10 needle punctures, 612 needle punctures, average puncture 7.2, and the positive rate of single needle for target group was 26.31. %, the system group was 12.94%, it can be seen that the target puncture reduced the number of puncture needle and increased the positive rate of prostate cancer by single needle. The difference was statistically significant (P0.05).3 puncture and postoperative pathological results: the target group puncture pathological results of prostate cancer Gleason score more than 7 points in 33 cases, postoperative pathological Gleason score more than 7 scores in 45 cases; system The pathological Gleason score of the group was more than 7 points in 20 cases, and the postoperative pathological Gleason score was more than 7 points, and the high score rate after the puncture was 62.26%, 45.45% respectively. The coincidence rate of the high score in the postoperative pathology was 73.33% and 42.55%, respectively. The coincidence rate of the puncture in the two groups was compared. The results showed that the coincidence rate of the target group was higher than that of the system puncture group, the difference was statistically significant. The sensitivity, specificity, positive predictive value and negative predictive value of prostate cancer in P0.05.4 target group were 89.83%, 84.62%, 92.98%, 78.57%, 88.24%, respectively, and 70.97%, 77.50%, 83.02%, 63.27%, 73.53%, respectively, compared with the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of group two. The sensitivity and accuracy of the target group were higher than that of the system group, the difference was statistically significant (P0.05); the specificity, positive predictive value and negative predictive value of the target group were higher than that of the system group, but there was no statistically significant difference (P0.05) in the two groups of prostate biopsy patients, 8 cases of hematuria, 7 cases of blood stool, 2 cases of hemato sperm, 1 cases of low fever, were found in the two groups of prostate biopsy patients. There were 21 cases of hematuria, 15 cases of hematuria, 5 cases of hematoresis, 3 cases of low fever and 2 cases of urinary retention. The results showed that the incidence of various complications in the system was higher than that in the target group, and the difference of hematuria was statistically significant (P0.05), and the total rate of complications in the target group was lower than that in the puncture group, the difference was statistically significant ( P0.05).6 was stratified according to PSA. Target puncture and systemic puncture positive and negative results showed that in patients with PSA level lower than 10ng/ml, target puncture and system puncture PCa detection rates were 31.25% and 19.23% respectively. In patients with PSA level 10~20ng/ml, the detection rate of target puncture and system puncture PCa were 42.86% and 32%, respectively, in PSA high. In the patients with 20ng/ml, the detection rates of targeted and systematic puncture PCa were 81.25% and 58.82%, respectively, and the PCa detection rate of target puncture was higher than that of system puncture in different PSA stratification. The results showed that the PCa detection rate of targeted puncture was higher than that of system puncture in patients with PSA higher than 20ng/ml. There were statistical significance (P0.05). Conclusion TRUS and ultrasound were found. Radiography combined with MRI guided prostate targeted puncture can obviously improve the detection rate of prostate cancer, reduce the number of puncture needles, improve the detection rate of prostate cancer with higher Gleason score, reduce the complications after the puncture, have high sensitivity to the detection of prostate cancer, and have high clinical value.

【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.25;R445

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