本文選題：前列腺癌 + 經(jīng)直腸超聲�。� 參考：《華北理工大學(xué)》2017年碩士論文

【摘要】：目的探討經(jīng)直腸超聲及超聲造影聯(lián)合MRI引導(dǎo)前列腺靶向穿刺的臨床應(yīng)用價(jià)值。方法選取2014年1月至2016年5月唐山工人醫(yī)院行前列腺穿刺活檢的、并經(jīng)手術(shù)病理證實(shí)的患者187例進(jìn)行回顧性分析,其中前列腺10點(diǎn)系統(tǒng)穿刺患者102例,靶向穿刺的患者85例,比較兩組穿刺前列腺癌的檢出率、穿刺針數(shù)及前列腺癌Gleason評(píng)分情況、穿刺后并發(fā)癥、兩組前列腺癌檢出效能、不同PSA分組時(shí)兩種方法的前列腺癌檢出率比較,看兩組差異是否有統(tǒng)計(jì)學(xué)意義。結(jié)果1靶向穿刺前列腺癌的檢出率為62.35%,系統(tǒng)穿刺檢出率為43.14%,術(shù)后陽性符合率靶向組為89.83%,系統(tǒng)穿刺組為70.97%,靶向組高于系統(tǒng)組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2系統(tǒng)穿刺共穿刺1020針,每人穿刺10針,靶向穿刺共穿刺612針,平均每人穿刺7.2針,單針陽性率靶向組為26.31%,系統(tǒng)組為12.94%,可以看出靶向穿刺減少了穿刺針數(shù),提高了單針檢出前列腺癌的陽性率,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3穿刺及術(shù)后病理結(jié)果:靶向組穿刺病理結(jié)果前列腺癌Gleason評(píng)分≥7分的為33例,手術(shù)后病理Gleason評(píng)分≥7分的為45例;系統(tǒng)組穿刺病理Gleason評(píng)分≥7分20例,手術(shù)后病理Gleason評(píng)分≥7分47例,穿刺后高分率分別為62.26%、45.45%,與術(shù)后病理中高分的符合率分別為73.33%、42.55%,比較兩組穿刺的高分符合率情況,結(jié)果顯示靶向組的符合率高于系統(tǒng)穿刺組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4靶向組檢出前列腺癌的敏感性、特異性、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值、準(zhǔn)確性分別為89.83%、84.62%、92.98%、78.57%、88.24%;系統(tǒng)穿刺組分別為70.97%、77.50%、83.02%、63.27%、73.53%,比較兩組的敏感性、特異性、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值和準(zhǔn)確性,結(jié)果顯示靶向組的敏感性和準(zhǔn)確性高于系統(tǒng)組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);靶向組的特異性、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值高于系統(tǒng)組,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。5兩組前列腺穿刺活檢患者中靶向穿刺中出現(xiàn)血尿者8例,血便者7例,血精2例,低熱1例;系統(tǒng)穿刺中血尿21例,血便15例,血精5例,低熱3例,尿潴留2例,結(jié)果顯示系統(tǒng)穿刺組的各種并發(fā)癥發(fā)生率均高于靶向穿刺組,其中血尿發(fā)生率的差異經(jīng)比較有統(tǒng)計(jì)學(xué)意義(P0.05),靶向穿刺組的并發(fā)癥合計(jì)率低于系統(tǒng)穿刺組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。6根據(jù)PSA進(jìn)行分層,靶向穿刺和系統(tǒng)穿刺陽性和陰性結(jié)果顯示,在PSA水平低于10ng/ml的患者中,靶向穿刺和系統(tǒng)穿刺PCa檢出率分別為31.25%和19.23%;在PSA水平為10~20ng/ml的患者中,靶向穿刺和系統(tǒng)穿刺PCa檢出率分別為42.86%和32.00%;在PSA高于20ng/ml的患者中,靶向穿刺和系統(tǒng)穿刺PCa檢出率分別為81.25%和58.82%;靶向穿刺的PCa檢出率在不同PSA分層中均高于系統(tǒng)穿刺,比較結(jié)果顯示在PSA高于20ng/ml的患者中,靶向穿刺的PCa檢出率高于系統(tǒng)穿刺,有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論TRUS及超聲造影聯(lián)合MRI引導(dǎo)前列腺靶向穿刺能明顯提高前列腺癌的檢出率,并且減少了穿刺針數(shù),能提高較高Gleason評(píng)分前列腺癌的檢出率,同時(shí)減少了穿刺術(shù)后并發(fā)癥,對(duì)前列腺癌的檢出有較高的敏感性,有較高的臨床應(yīng)用價(jià)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.

【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.25;R445

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本文編號(hào)：1847128