跨腹膜与跨直肠前列腺活检:随机对照试验的系统审查和元分析
Caio Vinicius Suartz1, Lucas Amorim Santos2, Caio Felipe Araujo Matalani2
1Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Department of Urology, INCT-UroGen, National Institute of Science, Technology and Innovation in Genitourinary Cancer, Campinas, São Paulo, Brazil.
Clinical genitourinary cancer
|December 12, 2025
概括
跨 (TP) 和跨直肠 (TR) 前列腺活检显示了类似的癌症检测和安全性. 轻度疼痛在TP活检中更为常见,但整体感染和并发症率在两种方法之间是可比的.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 在瘤学瘤学.
- 诊断成像 诊断成像 诊断成像
背景情况:
- 前列腺癌的诊断依赖于准确的成像和活检.
- 在超声波引导的前列腺活检中,采用了跨关节 (TP) 和跨直肠 (TR) 方法.
- 随机对照试验 (RCT) 对于比较这些活检技术的安全性和有效性至关重要.
研究的目的:
- 系统地比较跨腹膜 (TP) 与跨直肠 (TR) 超声波引导前列腺活检的诊断性能和安全性.
- 仅分析随机对照试验 (RCT) 的数据,以确保可靠的证据.
- 评估主要终点的癌症检测率和活检后感染率,以及二次结果,如并发症和疼痛.
主要方法:
- 在多个数据库中进行了系统的文献搜索,直到2025年5月.
- 仅包括直接比较男性接受MRI向前列腺活检的TP和TR活检方法的RCT.
- 对于分类结果,使用几率比率 (OR) 和95%置信区间 (CI) 进行了元分析,用Cochrane ROB2和GRADE.评估研究质量.
主要成果:
- 分析了包括2682名患者 (TP: 1323; TR: 1359) 在内的4个RCT.
- 在总体癌症检测率 (OR 1.03) 或前病变检测率 (OR 1.01) 中没有发现显著差异.
- 出血 (OR 1.14),尿 (OR 1.01),总感染 (OR 1.02) 和严重感染 (OR 2.17) 没有显著差异. 在TP组中,轻度疼痛更频繁 (OR 1.56),但中度至重度疼痛没有显著差异 (OR 0.65).
结论:
- 通过MRI融合指导的跨关节和跨直肠活检方法显示出同等的诊断准确性和安全性.
- 虽然跨关节路线可能与轻微增加的轻度不适有关,但癌症检测和并发症率相似.
- 在TP和TR活检之间进行选择时,应考虑抗菌药物管理,患者偏好和机构专业知识.
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