前列腺癌诊断的Transperineal Versus Transrectal 活检:随机对照试验的系统审查和元分析
Giancarlo Marra1, Francesca Bazzurro2, Alessandro Dematteis3
1Division of Urology, Department of Surgical Sciences, Città della Salute e della Scienza and University of Turin, Turin, Italy.
European urology oncology
|February 10, 2026
概括
跨膜前列腺活检 (TP-Bx) 在减少感染并发症而不会影响前列腺癌检测方面优于跨直肠活检 (TR-Bx). 由于其安全性和有效性,建议在可行的情况下使用TP-Bx.
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.
- 医疗成像医学成像
背景情况:
- 关于最优的前列腺活检路线存在争论:跨 (TP-Bx) 与跨直肠 (TR-Bx).
- 当代随机对照试验 (RCT) 提供了有关感染风险和诊断性能的新数据,鉴于抗生素耐药性和正在发展的前列腺癌 (PC) 诊断,这是至关重要的.
研究的目的:
- 为了比较TP-Bx和TR-Bx之间的传染性并发症和临床显著的PC (csPC) 检测.
- 评估在多参数核磁共振 (mpMRI) 时代为疑似PC进行活检的男性的其他活检相关结果.
主要方法:
- 对2010年以后发表的比较TP-Bx和TR-Bx的RCT进行系统的文献搜索.
- 贝叶斯随机效应的五项RCT (3072名男性) 的元分析,重点关注传染性并发症和csPC检测.
- 根据PRISMA和Cochrane指南进行数据提取和偏差风险评估.
主要成果:
- 与TR-Bx相比,TP-Bx显著降低了感染性并发症 (pOR 0.38),并显示出较低出血风险的趋势.
- 在两种方法之间检测到csPC (pOR 1.01) 或非临床显著PC (ncsPC) 之间没有发现显著差异.
- TP-Bx与患者报告的疼痛略高,操作时间更长有关,尽管临床相关性不确定.
结论:
- 与TR-Bx相比,TP-Bx在没有抗生素预防的情况下提供较低的感染风险和同等的PC检测率.
- 尽管不适和手术时间略有增加,但在可行的情况下,应考虑TP-Bx作为首选的活检方法.
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