本文選題：前列腺癌 + 診斷價值　； 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討影響前列腺穿刺檢出率的相關影響因素,并評估其對前列腺癌的臨床診斷效能。分析探討血清PSA系列指標、直腸指診、經直腸超聲、多參數(shù)MRI等前列腺癌早期檢查措施對臨床前列腺穿刺的指導價值。對比分析經直腸與經會陰不同入路穿刺方式對前列腺癌檢出率及術后并發(fā)癥的影響。方法:收集2005年至2015年10年間于天津醫(yī)科大學第二醫(yī)院行TRUS引導下前列腺穿刺活檢術病例的詳細臨床資料,主要包括穿刺前血清PSA系列值、前列腺體積、直腸指診及TRUS和多參數(shù)MRI、穿刺方式、穿刺術后病理等,比較相關檢查方式穿刺的敏感度、特異度及陽性率等相關指標,并評估對前列腺癌的早期診斷效能。重點探討當血清PSA值介于4-10ng/ml時,PSAD對前列腺癌的早期診斷價值,更好的指導臨床工作,進一步提高前列腺癌早期診斷陽性率,避免誤診、漏診。按穿刺方式分為經直腸前列腺穿刺組及經會陰模板定位前列腺穿刺活檢組2組,通過相關統(tǒng)計學方法比較兩種穿刺方式在穿刺陽性率、術后并發(fā)癥發(fā)生率等方面的差異。最終通過對相關指標、檢查方式及穿刺方式的分析,為臨床穿刺提供重要參考價值,進一步提高穿刺的陽性率,避免不必要的穿刺行為,減輕患者及家庭心理、醫(yī)療負擔。結果:DRE診斷早期前列腺癌的敏感性及特異度分別為40.2%及79.6%。經直腸超聲檢查診斷早期前列腺癌的敏感性及特異度分別為61.5%及68.4%。mp MRI診斷早期前列腺癌的敏感性及特異度分別為83.7%及79.3%。當TPSA介于4-10ng/ml時,前列腺穿刺的陽性率為21.2%。此時,良性增生組及前列腺惡性腫瘤組的PSAD及FPSA/TPSA相比,均具有顯著性差異。TPSA、FPSA/TPSA及PSAD三者中,PSAD在ROC曲線下的面積最大,提示當TPSA介于4-10ng/ml時,PSAD具較高的診斷價值,且高于FPSA/TPSA診斷價值。經直腸前列腺穿刺陽性率約為35%,經會陰模板定位前列腺穿刺術陽性率約為43.1%,后者明顯高于前者。兩種穿刺方式術后均存在不同程度的并發(fā)癥,同一種并發(fā)癥在兩種穿刺途徑中的發(fā)生率不同。經直腸途徑穿刺術后血便、感染的發(fā)生率明顯高于經會陰組,而經會陰穿刺術后會陰部出血腫痛的發(fā)生率明顯高于經直腸組。結論:1.前列腺癌的發(fā)病與年齡相關,臨床發(fā)現(xiàn)的前列腺癌患者年齡多在50歲以上,且隨年齡增長,發(fā)病率有逐漸上升趨勢,因此,推薦50歲以上男性常規(guī)行血清學PSA及泌尿系彩超檢查,定期篩查前列腺癌。2.血清學PSA檢測仍為目前應用最為廣泛的前列腺癌早期篩查指標,具有較高的前列腺癌診斷效能。但也存在特異性及敏感度不足等問題,聯(lián)合檢測PSAD、FPSA/TPSA等指標,可進一步提高前列腺癌診斷陽性率,避免誤診漏診。尤其當PSA介于4-10ng/ml時,PSAD的前列腺癌早期診斷效能較高。DRE及TRUS、多參數(shù)MRI等影像學檢查指標對提高前列腺癌診斷陽性率均有一定促進作用,單獨應用時往往存在敏感性不足等問題,多種篩查手段聯(lián)合使用往往能取得良好的診斷效果。3.當血清PSA位于診斷灰區(qū)時,經會陰模板定位前列腺穿刺陽性率明顯高于經直腸穿刺路徑,術后并發(fā)癥的發(fā)生率因并發(fā)癥類型不同而異�？紤]與前者穿刺針數(shù)較多、模板定位引導下穿刺部位更為精確等有關。經直腸組術后血便、感染等并發(fā)癥的發(fā)生率明顯高于經會陰組;而血尿、會陰部出血、腫痛的發(fā)生率明顯低于經會陰穿刺組。但后者也存在操作復雜、耗時長、留院時間長、麻醉時間長及需要特殊設備、不易推廣等不足之處。
[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.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.25

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