超声引导经会阴与经直肠前列腺穿刺活检诊断前列腺癌的比较研究
回顾性分析150例疑似前列腺癌患者，比较经会阴（62例）与经直肠（88例）超声引导穿刺活检。两组癌检出率无显著差异，但经会阴组穿刺时间更长，并发症、疼痛及焦虑抑郁评分更低。提示经会阴途径在减少术后并发症和负性情绪方面有优势。
要点
- 经会阴与经直肠穿刺前列腺癌检出率无显著差异。
- 经会阴途径并发症更少、疼痛更轻、负性情绪更低。
- 经会阴穿刺操作时间较经直肠延长约3分钟。
核心结论
- 两种超声引导前列腺穿刺活检均为有效诊断方法，经会阴途径在减少并发症、疼痛和负性情绪方面更具优势。
诊断标准与关键数值
- 经会阴组与经直肠组前列腺癌检出率分别为51.61%与43.18%，慢性前列腺炎为12.90%与18.18%，良性前列腺增生为35.48%与38.64%，差异均无统计学意义。
- 经会阴组穿刺时间22.92±2.02 min长于经直肠组19.70±1.93 min。
- 经会阴组总体并发症发生率20.97%低于经直肠组38.64%。
- 经会阴组术后VAS疼痛评分2.82±1.13低于经直肠组3.68±1.14。
- 经会阴组HAMA评分10.34±1.29、HAMD评分10.33±1.68分别低于经直肠组12.55±1.44、12.90±1.38。
临床应用与阅片要点
- 对于担心并发症或疼痛的患者，可优先考虑经会阴途径穿刺。
- 经会阴穿刺需预留更长操作时间，合理安排工作流程。
- 术后评估应包括疼痛及情绪状态，必要时给予干预。
局限性
- 本研究为单中心回顾性分析，样本量有限，可能存在选择偏倚。
- 未报告随机化、盲法及长期随访结果。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: Ultrasound-guided prostate biopsy is the standard method for the diagnosis of prostate cancer. However, the effect of the optimal puncture approach on diagnostic yield and patient outcomes remains controversial.
OBJECTIVE: To compare the diagnostic effectiveness and clinical outcomes of ultrasound-guided transperineal versus transrectal prostate aspiration biopsy in patients suspected of prostate cancer.
METHODS: A retrospective analysis was conducted on 150 patients who underwent prostate biopsy at our hospital between February 2020 and August 2024. Patients were divided into transperineal (n = 62) and transrectal (n = 88) groups. Key outcomes including cancer detection rate, complications, pain (VAS), and negative emotions were compared, with p < .05 indicating a statistically significant difference.
RESULTS: No significant difference was found between the transperineal and transrectal groups in the detection rates of prostate cancer (51.61% versus 43.18%), chronic prostatitis (12.90% versus 18.18%), or benign prostatic hyperplasia (35.48% versus 38.64%). Transperineal biopsy required longer puncture time (22.92 ± 2.02 min versus 19.70 ± 1.93 min), but resulted in fewer overall complications (20.97% versus 38.64%), lower post-procedure pain scores (VAS: 2.82 ± 1.13 versus 3.68 ± 1.14), and lower anxiety (HAMA: 10.34 ± 1.29 versus 12.55 ± 1.44) and depression scores (HAMD: 10.33 ± 1.68 versus 12.90 ± 1.38).
CONCLUSION: Both ultrasound-guided transperineal and transrectal prostate biopsies are effective diagnostic methods for prostate cancer. Transperineal biopsy offers advantages in reducing postoperative complications, pain, and negative emotional responses, supporting its preferential use in selected patients.
引用
- Cao Y, Zhu H, Wu J, et al. Ultrasound-Guided Transperineal Versus Transrectal Prostate Aspiration Biopsy in Diagnosing Prostate Cancer: An Observational Comparison Study. J Ultrasound Med. 2026. PMID: 41969148. doi:10.1002/jum.70255
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。