【摘要】：目的:比較不同血清PSA水平的前列腺穿刺陽性率及Gleason評分,探討血清PSA與前列腺穿刺陽性率及Gleason評分的關(guān)系。方法:收集2014年9月到2015年12月在吉林大學(xué)中日聯(lián)誼醫(yī)院就診的122例疑似前列腺癌患者的完整臨床資料,年齡范圍49-91歲,平均71.2±5.6歲,所有患者均行直腸指診、血清PSA、經(jīng)直腸前列腺彩超等檢查疑似前列腺癌,行超聲引導(dǎo)下前列腺穿刺活檢,其中55例行術(shù)中丁卡因膠漿局部浸潤麻醉,67例術(shù)中肛內(nèi)注射5ml碘伏,通過記錄術(shù)后VAS評分的方法評估局部浸潤麻醉對于疼痛的改善。穿刺病理結(jié)果回報確診為前列腺癌的患者共55例,根據(jù)血清PSA值的不同將其分為四組:A組(PSA4ng/ml)、B組(4ng/mlPSA10ng/ml)、C組(10ng/mlPSA20ng/ml)及D組(PSA≥20ng/ml),統(tǒng)計各組前列腺穿刺陽性率、Gleason評分,通過統(tǒng)計學(xué)比較不同血清PSA水平的前列腺穿刺陽性率及Gleason評分之間的關(guān)系,其中血清PSA介于4-20ng/ml之間以PSAD=0.19ng/(ml*cm3)為臨界值分為兩組,比較兩組之間前列腺穿刺陽性率的關(guān)系。結(jié)果:122例患者均順利完成彩超引導(dǎo)下前列腺10針系統(tǒng)穿刺。穿刺活檢術(shù)后病理確診為前列腺癌者共有55人(45.1%),前列腺增生者48例,前列腺炎者5例,前列腺上皮內(nèi)瘤12例,肉芽腫性前列腺炎1例,結(jié)核1例。Gleason評分≤7分共22例(40.0%)Gleason評分≥8分的共33例(60.0%)。1.A組共3例均因經(jīng)直腸彩超等提示異常回聲行前列腺穿刺活檢,確診為前列腺癌的1例,Gleason評分為6分。2.B組(4ng/mlPSA10ng/ml)、C組(10ng/mlPSA20ng/ml)與D組(PSA≥20ng/ml)的前列腺癌穿刺陽性率分別為17.4%(4/23)、31.7%(13/41)、67.3%(37/55),兩兩之間行卡方檢驗,B組與C組差異無統(tǒng)計學(xué)意義(p0.05),B組與D組差異具有統(tǒng)計學(xué)意義(p0.05),C組與D組差異亦具有統(tǒng)計學(xué)意義(p0.05)。3.B、C兩組患者,以PSA密度(PSAD)=0.195ng/(ml*cm3)為臨界值分為兩組,PSAD0.19ng/(ml*cm3)組與PSAD0.19ng/(ml*cm3)組的前列腺癌穿刺陽性率分別為10.7%(3/28)、38.9%(14/36),兩組之間前列腺穿刺陽性率具有統(tǒng)計學(xué)意義(p0.05)。4.B組(4ng/mlPSA10ng/ml)前列腺癌患者共4例,其Gleason評分均≤7分、C組(10ng/mlPSA20ng/ml)與D組(PSA≥20ng/ml)的Gleason評分≥8分的患者分別占38.5%(5/13)、75.7%(28/37),兩兩之間行卡方檢驗,B組與C組差異無統(tǒng)計學(xué)意義(p0.05),B組與D組差異具有統(tǒng)計學(xué)意義(p0.05),C組與D組差異亦具有統(tǒng)計學(xué)意義(p0.05)。5.丁卡因膠漿組術(shù)后VAS評分為2.109±0.685分,對照組術(shù)后VAS評分為4.179±0.851分,差異具有統(tǒng)計學(xué)意義(p0.05)。結(jié)論:1.前列腺癌穿刺陽性、Gleason評分與血清PSA值呈正相關(guān)關(guān)系,隨者血清PSA值的升高,前列腺穿刺陽性率升高,Gleason評分越高。2.當PSA位于4-20ng/ml時,以PSAD=0.19ng/(ml*cm3)為臨界值可以提高前列腺癌的穿刺陽性率。3.丁卡因膠漿局部麻醉可以降低前列腺穿刺活檢中的疼痛,是一種安全、有效的操作方法,值得推廣應(yīng)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 鹵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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