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目的:对于磁共振发现可疑病灶的患者,采取以穿刺可疑病灶区域为主,系统穿刺为辅的前列腺穿刺活检策略。探讨在保持总穿刺针数相对固定的前提下,通过重点穿刺磁共振可疑病灶来提高前列腺癌检出率的方法。方法:选取多参数磁共振发现的可疑前列腺癌患者461例,回顾分析其中多参数MRI可疑病灶均为单个,10μg/L≤PSA<20μg/L的患者262例。所有患者均采用MRI/TRUS融合成像引导靶向穿刺的方法。其中采取“6X+6”穿刺法的患者134例,常规“12+2X”法穿刺128例。“6X+6”穿刺法:采取以穿刺MRI可疑区域为主,随机穿刺为辅的策略,对于MRI可疑病灶区域重点穿刺6针,其余部位系统穿刺6针。常规“12+2X”穿刺法:即系统穿刺12针,可疑部位穿刺2针。比较两组穿刺活检的可疑病灶前列腺癌检出率,总前列腺癌检出率,以及并发症差异。分析可疑病灶的PI-RADS评分值,分布部位,横截面积以及直径等参数。分析各组前列腺癌穿刺阳性者Gleason评分的分布情况。结果:“6X+6”穿刺组与“12+2X”穿刺组的总前列腺癌检出率分别为44.8%与37.5%,两组中可疑病灶检出的前列腺癌占总前列腺癌的比例分别为37.3%与27.3%。“6X+6”穿刺组的这两项指标均高于“12+2X”穿刺组,两者差异均有统计学意义(P<0.05)。MRI可疑病灶分布部位以前列腺中部最多(45%)。横截面积为(0.48±0.11)cm~2,癌灶直径为(8.51±2.21)mm。穿刺结果显示,两组低级别肿瘤(Gleason3+3=6分)占多数,“6X+6”组为68%,“12+2X”组为71%。“12+2X”组有1例患者出现迷走神经反射,两组其余患者均可耐受局麻下的穿刺活检。两组穿刺后尿潴留、血尿、血便和发热等并发症均无统计学差异。结论:当多参数MRI发现可疑病灶时,在保持总穿刺针数一定的前提下,与传统“12+2X”穿刺法比较,采取重点穿刺MRI可疑病灶区域,以系统穿刺为辅的策略(“6X+6”穿刺法),可明显提高前列腺癌的检出率,穿刺后并发症发生率差异无统计学意义。
Objective: For patients with suspicious lesions found by magnetic resonance, a biopsy strategy of prostate biopsy based on punctured suspicious lesions and supplemented by systemic puncture is adopted. To explore the method of improving the detection rate of prostate cancer by focusing on the suspicious lesions of magnetic resonance on the premise of keeping the total number of puncturing needle fixed. Methods: A total of 461 suspicious prostate cancer patients were detected by multiparameter MRI. Among them, 262 patients with multi-parameter MRI suspicious lesions were all single and 10μg / L≤PSA <20μg / L were retrospectively analyzed. All patients used MRI / TRUS fusion imaging to guide the method of targeted puncture. Among them, 134 cases were treated by “6X + 6” puncture and 128 cases were punctured by conventional “12 + 2X” method. “6X + 6 ” puncture method: take the puncture of MRI suspicious area, random puncture supplemented by the strategy, the focus of MRI suspicious lesions puncture 6-pin, the rest of the system puncture 6-pin. Conventional “12 + 2X” puncture method: that is, the system puncture 12-pin, suspicious parts puncture 2-pin. Prostate cancer detection rate, total prostate cancer detection rate, and complications were compared between two groups of biopsy specimens. PI-RADS scores, distribution sites, cross-sectional area and diameter of suspicious lesions were analyzed. The distribution of Gleason score in each group of prostatic cancer positive patients was analyzed. Results: The detection rates of total prostate cancer in “6X + 6” puncture group and “12 + 2X” puncture group were 44.8% and 37.5% respectively. The total number of prostate cancer detected by suspicious lesions in both groups was The proportions were 37.3% and 27.3% respectively. The “6X + 6” puncture group was higher than those of the “12 + 2X” puncture group, both of which were statistically significant (P <0.05). Suspected lesions of MRI distribution in the middle part of the largest prostate (45%). The cross-sectional area was (0.48 ± 0.11) cm ~ 2 and the diameter of the tumor was (8.51 ± 2.21) mm. The puncture results showed that the two groups of low-grade tumors (Gleason3 + 3 = 6) accounted for the majority, 68% in the “6X + 6” group and 71% in the “12 + 2X” group. One patient in the “12 + 2X” group had vagal reflexes and the remaining patients in both groups were able to tolerate the biopsy under local anesthesia. There was no significant difference in urinary retention, hematuria, bloody stools and fever in two groups after puncture. Conclusion: When multi-parameter MRI found suspicious lesions, while maintaining the total number of puncturing needle under the premise, compared with traditional “12 + 2X” puncture method, take the focus of punctured MRI suspicious lesion area, supplemented by the system puncture Strategy ( “6X + 6 ” puncture), can significantly improve the detection rate of prostate cancer, postoperative puncture rate of complications was not statistically significant.