经直肠超声诊断前列腺癌临床价值.docVIP

经直肠超声诊断前列腺癌临床价值 　【摘要】 ［目的］ 探讨经直肠超声检查诊断前列腺癌的临床价值。［方法］ 32例血清前列腺特异性抗原升高或直肠指诊阳性的前列腺患者，经直肠超声检查引导穿刺活检。［结果］ 32例患者中，病理证实前列腺癌30例、移行细胞癌及黏液腺癌各1例。按声像图表现分为弥漫型、结节型及无结节型。经直肠超声检出异常结节23 个，病理证实为癌性结节14个，增生结节9个。 ［结论］ 经直肠超声声像图有较高的敏感性。经直肠超声穿刺活检有助于提高前列腺癌的诊断。 【关键词】 经直肠 超声 前列腺肿瘤 病理学 Clinical Value of Transrectal Ultrasonography for Diagnosing Prostate Cancer SUN Feng, CHEN Li-xin, WU Ying, et al. (Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, Shenzhen 518020, Guangdong) Abstract: ［Purpose］ To evaluate the clinical value of transrectal ultrasound (TRUS) examination on diagnosing prostate cancer. ［Methods］ Thirty?鄄two cases of prostate cancer with prostate specific antigen (PSA) greater or abnormal digital rectal examination underwent tranrectal ultrasound?鄄guided prostatic biopsies. ［Results］ Of 32 cases, 30 with adencarcinoma, 1 with transitional cell carcinoma and 1 with mucinous adenocarcinoma were pathologically proved. Ultrasonography was classified into diffuse type, nodular type and non?鄄nodular type. Abnormal nodules were founded in 23 cases by TRUS. Of them, 14 carcinormatous nodules and 9 hyperplasia nodules were proved by pathology. ［Conclusion］ TRUS has a better sensitivity. Ultrasound?鄄guided transrectal prostatic biopsy is helpful for improving the accuracy of prostate cancer diagnosis. Key words: transrectal; ultrasound; prostate neoplasms; pathology 经直肠超声检查（TRUS）是前列腺疾病较为准确的筛查手段，但前列腺癌早期常无特异性的声像图表现，与其它前列腺疾病如前列腺炎、良性前列腺增生难以鉴别。后两者的发病率也很高。对癌与非癌性病变进行鉴别，是临床和影像学面临的一个难题。本文回顾分析TRUS引导穿刺活检病理确诊的前列腺癌声像图，目的在于总结其特征性表现，提高诊断准确率。 1 材料与方法 1.1 研究对象 2003年11月至2006年3月间因血清前列腺特异性抗原（PSA）升高或直肠指诊（DRE）阳性的本院门诊及住院患者32例，年龄58~88岁，平均67.9岁；血清PSA正常1例（正常值＜4.0ng/ml；血清PSA异常31例（PSA 7.1ng/ml~167ng/ml，平均 65.6ng/ml）。 1.2 研究方法 仪器PHILIPS IU22及Acuson Sequoia 512彩色多普勒超声诊断仪，采用经直肠端扫式变频探头，频率为6~10MHz。配备直肠探头穿刺架，穿刺针为18G Quickcut?鄄C2型手动活检针，取材长度1.5cm。光盘存储图像。 每例患者在穿刺前均进行TRUS检查，被检查者屈膝左侧卧位，经DRE检查后，探头置于患者直肠内进行超声检查，测量前列腺及内腺的上下、左右及前后径，观察前列腺内部回声及血流情况。重点观察前列腺内的结节样回声及其周边和内部的血流情况。结节区域血流信号丰富