本文選題：前列腺癌　切入點(diǎn)：tPSA　出處：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：前列腺癌為泌尿外科的常見惡性腫瘤之一。近年來相關(guān)研究資料顯示，我國(guó)前列腺癌的發(fā)病率呈上升趨勢(shì)。本文通過回顧性臨床研究旨在比較分析前列腺癌各種檢查方法的優(yōu)缺點(diǎn)以改進(jìn)其診斷方法。 方法：搜集我院2009年到2013年之間經(jīng)術(shù)后病理確定為前列腺癌患者210例，整理分析其臨床資料，應(yīng)用AJCC的TNM分期系統(tǒng)分期，比較各診斷方法，，如直腸指診、血清PSA檢驗(yàn)、前列腺穿刺活檢等，統(tǒng)計(jì)方法各變量頻數(shù)以百分率表示，率的比較、計(jì)數(shù)資料的比較分析采用卡方檢驗(yàn)，P0.05具有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.210例前列腺癌患者，年齡52-86歲，平均年齡為72歲。其中：小于60歲組15列（7.1%），60歲到80歲之間143例（68.1%），大于80歲52例（24.8%）。 2.有臨床癥狀197例（93.8%），癥狀包括血尿患者95例（45.2%）、下尿路癥狀185例（88.1%）（包括排尿困難、尿頻尿急尿痛及尿潴留等），無臨床癥狀因體檢或前列腺增生術(shù)后病理偶然發(fā)現(xiàn)13例（6.2%）。分期T1-28例（3.8%），T3-4202例（96.2%）。全身骨掃描示轉(zhuǎn)移89例（67.4%），無轉(zhuǎn)移43例（32.6%）。 3.血清tPSA值4ng/ml190例（90.5%）；4ng/ml20例（9.5%）；4-10ng/ml13例（6.2%）；10ng/ml177例（84.3%；，f/t0.16為30例（14.3%），0.16為180例（85.7%）。210例患者臨床分期及相應(yīng)血清PSA值，分別為：T1-28例，PSA（14.7±2.0）ng/ml；T3103例，PSA（62.4±5.3）ng/ml；T499例，PSA（89.4±10.6）；相關(guān)回歸分析顯示：PSA與臨床分期顯著相關(guān)（P0.001）。 4.210例中行全身骨掃描132例，發(fā)現(xiàn)骨轉(zhuǎn)移89例（67.4%），無轉(zhuǎn)移43例（32.6%），取PSA值20ng/ml為臨界值預(yù)測(cè)其前列腺癌骨轉(zhuǎn)移的靈敏度、特異性和準(zhǔn)確性分別為87.6%（78/89）、67.4%（29/43）和81.1%（107/132）。 5.210例患者均行DRE檢查，前列腺癌DRE特征為觸及結(jié)節(jié)或質(zhì)地堅(jiān)硬，本組DRE提示前列腺癌113例（53.4%)。 6.210例中行6針法穿刺活檢31例，其中30例病理結(jié)果為陽(yáng)性，穿刺陽(yáng)性檢出率達(dá)96.8%。 7.本組210前列腺癌病例中行CT檢查138例，其中CT結(jié)果診斷前列腺癌49例，診斷正確率35.5%，其中，不同臨床分期CT診斷正確率分別為：T1-2期1/8例（12.5%），T3-4期48/202例（23.8%）；行MRI41例，MRI結(jié)果診斷前列腺癌32例，診斷正確率78.0%；其中不同臨床分期MRI診斷正確率分別為：T1-2期3/8例（37.5%），T3-4期38/202例（14.4%）。 結(jié)論 1.60-80歲為前列腺癌的高發(fā)年齡，男性從50歲開始應(yīng)每年常規(guī)行PSA檢測(cè)及DRE檢查。血清PSA小于10ng/ml時(shí)，應(yīng)結(jié)合患者年齡、f/t比值密切隨診及進(jìn)一步檢查。 2.PSA值在預(yù)測(cè)前列腺癌骨轉(zhuǎn)移上具有臨床意義，PSA大于20ng/ml時(shí)，骨轉(zhuǎn)移可能性極大。DRE與PSA檢測(cè)聯(lián)合應(yīng)用能提高前列腺癌的陽(yáng)性診出率。 3.經(jīng)直腸前列腺穿刺活檢可以確定診斷，PSA正常但DRE為陽(yáng)性者，應(yīng)盡早行穿刺活檢。 4.CT及MRI對(duì)前列腺癌診斷陽(yáng)性率不夠，但在分期診斷中有重要意義。 5.部分前列腺癌PSA可能正常。
[Abstract]:Objective: prostate cancer is one of the most common malignant tumors in urology. The incidence of prostate cancer in China is on the rise. The purpose of this paper is to compare and analyze the advantages and disadvantages of various examination methods of prostate cancer in order to improve their diagnostic methods. Methods: 210 cases of prostate cancer confirmed by postoperative pathology between 2009 and 2013 were collected and analyzed. The clinical data were analyzed and the TNM staging system of AJCC was used to compare the diagnosis methods, such as rectal digital diagnosis and serum PSA test. Prostate biopsy and so on, the statistical method of the frequency of the variables expressed as a percentage, the rate of comparison, counting data of comparative analysis using chi-square test (P0.05) has statistical significance. Results. 1.210 patients with prostate cancer, 52 to 86 years old, with an average age of 72 years. 2. There were 197 patients with clinical symptoms, including 95 patients with hematuria, 95 patients with hematuria, 185 patients with lower urinary tract symptoms, including dysuria. No clinical symptoms were found in 13 cases of prostatic hyperplasia by chance because of physical examination or pathology after prostatic hyperplasia. Staging T _ (1-28) cases with T _ (3) and T _ (3) ~ (4202) cases with T3-4202 cases with 96.22.The whole body bone scan showed metastasis in 89 cases (67.4%), and no metastasis in 43 cases (32.6%). 3. The serum tPSA value of 4ng/ml190 was 90.5 ng / ml = 9.5ngml = 9.5ngml = 9.5ngml / ml 13 cases respectively and 62.4 鹵5.3ngml / ml 13 cases and 84.3ng/ ml / 177ng / ml 13 cases respectively. The correlation regression analysis showed that there was a significant correlation between the clinical stage and the corresponding serum PSA value of 180 patients (85.77.210 cases), and the correlation regression analysis showed that there was a significant correlation between PSA and clinical staging in 89.4 鹵610.210 cases of PSA-positive patients. The regression analysis showed that there was a significant correlation between PSA and clinical stage in 89.4 鹵610.10% cases of PSAA. The regression analysis showed that there was a significant correlation between PSA and clinical stages. The correlation regression analysis showed that there was a significant correlation between PSA and clinical stages. Of the 4.210 cases, bone metastases were found in 89 cases (67.4%) and no metastasis in 43 cases (32.6%). The sensitivity of PSA 20ng/ml was taken as the critical value to predict the bone metastasis of prostate cancer. The specificity and accuracy were 87.6 / 89 / 67.4 / 29 / 43 and 81.1 / 137 / 132respectively. DRE examination was performed in all 5.210 patients. The DRE of prostate cancer was characterized by touching nodule or hard texture. DRE suggested that there were 53.4% prostate cancer cases in this group. Among the 6.210 cases, 31 cases were performed 6 needle biopsy, 30 of them were positive in pathology, the positive rate of puncture was 96.8%. In this group of 210 cases of prostate cancer, 138 cases were examined by CT, 49 cases of which were diagnosed by CT, the correct rate of diagnosis was 35. 5%. The correct rate of CT diagnosis in different clinical stages was: 1 / 1 / 1 / 8 of stage 1: 1 / 1, 12. 5% and 48 / 202 of stage T3-4, respectively; 32 cases of prostate cancer were diagnosed by MRI41, the diagnostic accuracy rate was 78.0, and the correct rate of diagnosis of MRI in different clinical stages was T: 1-2 3 / 8 cases with 37.5% T3-4 stage and 38 / 202 cases with T 3 / 4 stage and 14. 4% respectively. Conclusion. 1.60-80 years old is the high risk age of prostate cancer, male should routine PSA test and DRE examination every year from 50 years old. When the serum PSA is less than 10ng/ml, it should be closely followed up and further checked in combination with the patient's age / f / t ratio. The value of 2.PSA has clinical significance in predicting bone metastasis of prostate cancer. When the probability of bone metastasis is greater than that of 20ng/ml, the combination of Dre and PSA can improve the positive diagnosis rate of prostate cancer. 3. Transrectal prostate biopsy can confirm the diagnosis of normal PSA but positive DRE, should be performed as early as possible. The positive rate of 4.CT and MRI in the diagnosis of prostate cancer is not enough, but it is important in staging diagnosis. 5. Partial prostate cancer PSA may be normal.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.25

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 張尚文;;直腸指診與超聲檢查診斷前列腺癌[J];國(guó)外醫(yī)學(xué)(老年醫(yī)學(xué)分冊(cè));1992年05期

2 暢晉軍;;f-PSA/T-PSA在前列腺增生與前列腺癌鑒別診斷中的意義[J];臨床醫(yī)藥實(shí)踐雜志;2008年07期

3 肖序仁,史立新,王曉雄,洪寶發(fā),葉林陽(yáng),張磊,蔡偉,高江平,盧錦山,李炎唐;317例前列腺癌診斷分析[J];中華泌尿外科雜志;2002年09期

本文編號(hào)：1688607