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经会阴前列腺穿刺活检的再认识

Reevaluation of transperineal prostate biopsy

摘要:

20多年来,经直肠途径前列腺穿刺活检因其方便和低成本等优点一直是前列腺穿刺活检的主流,远多于经会阴途径活检.但经直肠途径活检也有其不足:存在前列腺前尖部盲区,易漏诊该部位肿瘤;有较高的脓毒血症发生风险.而经会阴途径活检在这些方面有一定的优势,具体表现为:前列腺前尖部肿瘤阳性率高;可准确地评估肿瘤体积并进行Gleason评分;提供前列腺癌病灶空间分布;和前列腺癌根治术后大体病理一致性好;低感染率,适合感染高危人群.经会阴途径活检可能再次成为前列腺穿刺活检主流.近几年来,随着大多采用经会阴途径活检的多参数MRI引导下的靶向穿刺活检的应用,经会阴途径活检技术得到了更好的推广.

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abstracts:

In these recent over twenty years, transrectal prostate biopsy takes predominant place in diagnosing prostate cancer for its relatively convenient procedure and low cost.In contrast, transperineal biopsy approach is much less popular.However, transrectal prostate biopsy has disadvantages of " blind region" in the anterior apex regions of the prostate gland and relatively high risk of biopsy associated sepsis.The transperineal biopsy approach is again gaining attention and even becoming a mainstream approach.The advantages of transperineal prostate biopsy are the following: a high positive rate, particularly in the detection of tumors at the anterior or apical prostate;accurate assessment of the volume and Gleason score of prostate cancer;the possibility of providing information about the spatial distribution of the cancer;good consistency of pathology with radical resection;and a lower infection rate, making it suitable for patients with a high infection risks.The expansion of transperineal biopsy has been propagated by the increase in multiparametric MRI-guided biopsies, which often use the transperineal approach.

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