TPPB与TRPB在前列腺癌腹腔镜手术中的应用效果及安全性比较

doi:10.3760/cma.j.cn441417-20250115-13002

摘要/Abstract

摘要：

目的　比较经会阴前列腺穿刺（TPPB）与经直肠前列腺穿刺（TRPB）在前列腺癌腹腔镜手术中的应用效果及安全性。方法　回顾性分析2023年1月至2024年10月陕西省人民医院接诊的98例前列腺癌患者的临床资料，按照穿刺活检方式分为TPPB组50例、TRPB组48例。TPPB组年龄（60.34±6.87）岁，前列腺体积（38.54±5.83）ml，疾病分期Ⅰ期21例、Ⅱ期29例。TRPB组年龄（60.93±6.25）岁，前列腺体积（38.10±5.32）ml，疾病分期Ⅰ期23例、Ⅱ期25例。两组患者均在穿刺活检术后4周接受腹腔镜手术。比较两组穿刺活检情况、腹腔镜手术情况、血清前列腺特异性抗原（PSA）变化及并发症发生率。采用t检验及χ²检验进行统计学分析。结果　TPPB组穿刺时间为（18.94±2.04）min，短于TRPB组（23.65±2.71）min（P<0.05）。TPPB组手术时间、直肠间隙分离时间为（115.83±7.61）min、（18.20±2.54）min，均短于TRPB组的（134.50±8.57）min、（32.58±2.73）min（均P<0.05）；TPPB组术中失血量为（203.12±24.83）ml，少于TRPB组的（239.61±27.51）ml（P<0.05）。两组手术前后PSA水平比较差异均无统计学意义（均P>0.05）。TPPB组发热、穿刺点出血发生率为2.00%（1/50）、4.00%（2/50），低于TRPB组的12.50%（6/48）、20.83%（10/48）（均P<0.05）。结论　与TRPB相比，TPPB用于前列腺癌患者效果较好，可减少腹腔镜手术中创伤、降低并发症发生率，安全性更好

关键词: 前列腺癌, 经会阴前列腺穿刺, 经直肠前列腺穿刺, 腹腔镜, 并发症

Abstract:

Objective　To compare the efficacies and safety of transperineal prostate biopsy (TPPB) and transrectal prostate biopsy (TRPB) in laparoscopic surgery for prostate cancer. Methods　Clinical data of 98 patients with prostate cancer admitted to Shaanxi Provincial People's Hospital from January 2023 to October 2024 were retrospectively analyzed, and they were divided into a TPPB group (50 cases) and a TRPB group (48 cases) according to different biopsy methods. In the TPPB group, the age was (60.34±6.87) years old, the prostate volume was (38.54±5.83) ml, and the disease stages were stage Ⅰ in 21 cases and stage Ⅱ in 29 cases. In the TRPB group, the age was (60.93±6.25) years old, the prostate volume was (38.10±5.32) ml, and the disease stages were stage Ⅰ in 23 cases and stage Ⅱ in 25 cases. Both groups underwent laparoscopic surgery 4 weeks after biopsy. The puncture biopsy conditions, laparoscopic surgery conditions, change in serum prostate-specific antigen (PSA), and incidence of complications were compared between the two groups. t-test and χ² test were used for statistical analysis. Results　The puncture time of the TPPB group was (18.94±2.04) min, which was shorter than that of the TRPB group [(23.65±2.71) min] (P<0.05). The operation time and the time for rectal space separation in the TPPB group were (115.83±7.61) min and (18.20±2.54) min, which were both shorter than those in the TRPB group [(134.50±8.57) min and (32.58±2.73) min] (both P<0.05); the intraoperative blood loss in the TPPB group was (203.12±24.83) ml, which was less than that in the TRPB group [(239.61±27.51) ml] (P<0.05). There was no statistically significant difference in the PSA level between the two groups before and after surgery (both P>0.05). The incidences of fever and puncture site bleeding in the TPPB group were 2.00% (1/50) and 4.00% (2/50), which were lower than those in the TRPB group [12.50% (6/48) and 20.83% (10/48)] (both P<0.05). Conclusion　Compared with TRPB, TPPB is more effective in prostate cancer patients, which can reduce the trauma and complications during laparoscopic surgery, with better safety

Key words: Prostate cancer, , Transperineal prostate biopsy, , Transrectal prostate biopsy, , Laparoscopy, , Complications

曹建伟段万里程继董青川付国.

TPPB与TRPB在前列腺癌腹腔镜手术中的应用效果及安全性比较 [J]. 国际医药卫生导报, 2025, 31(13): 2118-2122.

Cao Jianwei, Duan Wanli, Cheng Ji, Dong Qingchuan, Fu Guo.

Comparison of efficacies and safety of TPPB and TRPB in laparoscopic surgery for prostate cancer [J]. International Medicine and Health Guidance News, 2025, 31(13): 2118-2122.

参考文献

[1]林豪胜,杨增士,叶宁.基于年龄-时期-队列模型的中国前列腺癌发病死亡趋势分析[J].临床泌尿外科杂志,2024,39(8):708-712. DOI:10.13201/j.issn.1001-1420.2024.08.011.

[2]张燕,糜远源,孙丽雅,等.前列腺癌患者与主要照顾者相依关系对积极感受的影响[J].国际医药卫生导报,2024,30(13):2253-2259. DOI:10.3760/cma.j.issn.1007-1245.2024.13.027.

[3] Sosenko A, Owens RG, Yang AL, et al. Non-infectious complications following transrectal prostate needle biopsy - outcomes from over 8000 procedures[J]. Prostate Int, 2022, 10(3):158-161. DOI: 10.1016/j.prnil.2022.04.002.

[4] Parkin CJ, Gilbourd D, Grills R, et al. Transrectal ultrasound-guided prostate needle biopsy remains a safe method in confirming a prostate cancer diagnosis: a multicentre Australian analysis of infection rates[J]. World J Urol, 2022, 40(2):453-458. DOI: 10.1007/s00345-021-03862-8.

[5]王海跞,庞昆,王靖凯,等.经会阴与经直肠前列腺穿刺对诊断PSA灰区/亚灰区患者前列腺癌应用价值的比较研究[J].新医学,2024,55(2):132-137. DOI:10.3969/j.issn.0253-9802.2024.02.011.

[6]岳敏,栾阳,阮亚俊,等.经会阴与经直肠前列腺穿刺活检对前列腺癌的诊断效能和并发症比较[J].临床外科杂志,2024,32(7):753-756. DOI:10.3969/j.issn.1005-6483.2024.07.022.

[7]赫捷,陈万青,李霓,等.中国前列腺癌筛查与早诊早治指南(2022,北京)[J].中华肿瘤杂志,2022,44(1):29-53.DOI:10.3760/cma.j.cn112152-20211226-00975.

[8]王丹,邹雪平,成姝雯,等.2015-2019年四川省肿瘤登记地区前列腺癌流行特征及早死疾病负担趋势分析[J].中国肿瘤,2024,33(9):709-715. DOI:10.11735/j.issn.1004-0242.2024.09.A002.

[9]赵俊峰,何丽华,李为翊,等.2002-2019年黄浦区前列腺癌发病和死亡趋势[J].预防医学,2024,36(10):878-881,886. DOI:10.19485/j.cnki.issn2096-5087.2024.10.012.

[10] O'Connor E, Dowling C, Casey M, et al. Implications of a diagnosis of atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) on prostate biopsy: a 5-year follow-up study[J]. Ir J Med Sci, 2022, 191(5):2035-2040. DOI: 10.1007/s11845-021-02854-2.

[11] Günzel K, Magheli A, Busch J, et al. Evaluation of systematic prostate biopsies when performing transperineal MRI/TRUS fusion biopsy with needle tracking-what is the additional value?[J]. Int Urol Nephrol, 2022, 54(10):2477-2483. DOI: 10.1007/s11255-022-03309-y.

[12]何佳,刘宁,于田强,等.超声造影精准穿刺在经直肠前列腺穿刺活检中的应用[J].中华全科医学,2023,21(11):1920-1923. DOI:10.16766/j.cnki.issn.1674-4152.003258.

[13]陈天泽,朱芮,浦金贤.经直肠超声联合多参数磁共振前列腺穿刺活检研究进展[J].微创泌尿外科杂志,2024,13(1):62-67. DOI:10.19558/j.cnki.10-1020/r.2024.01.013.

[14] Fuletra J, Rjepaj C, Clark JY, et al. Significant bleeding complications following transrectal prostate needle biopsy: incidence, predictors, and management[J]. Urol Pract, 2023, 10(1):6-8. DOI: 10.1097/UPJ.0000000000000349.

[15]樊丽丽,兰琦玉,毛玲玲,等.超声引导下经直肠前列腺穿刺活检漏诊前列腺癌患者临床特征及原因分析[J].临床误诊误治,2023,36(9):22-27,33. DOI:10.3969/j.issn.1002-3429.2023.09.006.

[16]王林峰,罗生军,唐伟.经直肠和经会阴前列腺穿刺对前列腺癌诊断价值的比较[J].重庆医科大学学报,2023,48(8):921-925. DOI:10.13406/j.cnki.cyxb.003296.

[17]纪俊标,唐庆来,王杜渐,等.超声引导下经会阴与经直肠途径在前列腺穿刺活检中的疗效比较[J].国际泌尿系统杂志,2024,44(5):797-800. DOI:10.3760/cma.j.cn431460- 20230210-00202.

[18]李鑫,毕国风,徐阳,等.经会阴前列腺穿刺活检术疼痛风险评估模型的构建[J].中国男科学杂志,2024,38(1):62-69. DOI:10.3969/j.issn.1008-0848.2024.01.008.

[19]唐静,于烔君,黄艺,等.双平面超声在经会阴前列腺穿刺活检中的应用及效果分析[J].中国现代手术学杂志,2024,28(2):140-144. DOI:10.16260/j.cnki.1009-2188. 2024.02.010.

[20]韩广业,马阔,宋伟航,等.前列腺穿刺术后不同时机行腹腔镜前列腺癌根治术的效果与安全性的前瞻性随机对照研究[J].海南医学,2024,35(16):2320-2324. DOI:10.3969/j.issn.1003-6350.2024.16.008.

[21]杨迎中.腹腔镜前列腺根治术与开腹根治术治疗前列腺癌的临床疗效比较[J].中国药物与临床,2021,21(3):409-411. DOI:10.11655/zgywylc2021.03.017.

[22]潘润阳,苏文星,林荣凯.经会阴前列腺穿刺活检在前列腺癌腹腔镜手术中的应用效果及安全性探究[J].微创泌尿外科杂志,2024,13(3):176-182. DOI:10.19558/j.cnki. 10-1020/r.2024.03.007.

[23]刘赛,王明帅,曹文,等.经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的对比分析[J].首都医科大学学报,2021,42(3):470-474. DOI:10.3969/j.issn.1006-7795. 2021.03.022.

[24]郭晨东,蒲杰,胡益民.不同麻醉药物联合应用于老年男性患者经会阴前列腺穿刺活检术:一项单中心、前瞻性、随机对照试验[J].中华男科学杂志,2024,30(10):896-902. DOI:10.13263/j.cnki.nja.2024.10.006.

[25]张芹芹,薛庆,施赛叶,等.风险管理在高龄经会阴前列腺穿刺患者中的应用[J].现代泌尿生殖肿瘤杂志,2023,15(6):363-365,372. DOI:10.3870/j.issn.1674-4624.2023.06.010.