[1]张琪颂王峰陈兆旭张鹏程支运来蔡成宽吉振帅谢程毛利军①孙方浒**.经尿道前列腺外周带切除术在血前列腺特异性抗原升高且穿刺阴性患者中的应用[J].中国微创外科杂志,2026,01(6):342-347.
　Zhang Qisong,Wang Feng,Chen Zhaoxu,et al.Application of Transurethral Resection of the Peripheral Zone of the Prostate in Patients With Elevated Serum PSA and Negative Biopsy[J].Chinese Journal of Minimally Invasive Surgery,2026,01(6):342-347.
点击复制

经尿道前列腺外周带切除术在血前列腺特异性抗原升高且穿刺阴性患者中的应用()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2026年6期
页码:
342-347
栏目:
临床研究
出版日期:
2026-06-22

文章信息/Info

Title:
Application of Transurethral Resection of the Peripheral Zone of the Prostate in Patients With Elevated Serum PSA and Negative Biopsy
作者:
张琪颂王峰陈兆旭张鹏程支运来蔡成宽吉振帅谢程毛利军①孙方浒**
(徐州医科大学附属连云港医院连云港市第一人民医院泌尿外科，连云港222000)
Author(s):
Zhang Qisong;  Wang Feng;  Chen Zhaoxu;  et al.
Department of Urology, Affiliated Lianyungang Hospital of Xuzhou Medical University, First People’s Hospital of Lianyungang, Lianyungang 222000, China
关键词:
前列腺增生; 等离子体; 经尿道前列腺切除术; 外周带
Keywords:
Prostatic hyperplasia; Plasma; Transurethral resection of prostate; Peripheral zone
文献标志码:
A
摘要:
目的探讨应用等离子体行经尿道前列腺外周带切除术诊治血前列腺特异性抗原(prostate special antigen，PSA)升高且穿刺阴性的前列腺增生患者的可行性。方法2022年1月~2025年6月，选取有明显下尿路梗阻症状伴PSA升高、前列腺穿刺活检阴性的前列腺增生患者106例，行经尿道前列腺外周带切除术。先用等离子体剜除增生的中心带，吸出组织，再切除外周带组织，切下组织分别送病理检查。结果106例均顺利完成手术。手术时间(57.4±10.6)min，其中中心带(30.7±6.6)min，外周带(26.6±8.0)min。术中出血量(140.1±53.0)ml。术中前列腺包膜穿孔17例，精囊切破8例。病理诊断良性前列腺增生77例，其中8例伴高级别前列腺上皮内瘤变(prostatic intraepithelial neoplasia，PIN)，位于中心带2例，外周带6例；前列腺腺癌29例，位于中心带7例(Gleason评分≤6分4例，≥7分3例)，外周带19例(Gleason评分≤6分9例，≥7分10例)，外周带及中心带均有3例(2例Gleason评分6分，1例7分)。术后随访6~24个月，平均11.9月。术后3个月血PSA<0.01 μg/L 64例，0.01~0.2 μg/L 32例，0.2~1.0 μg/L 10例。7例前列腺癌术后3个月行腹腔镜前列腺根治性切除术，病理未见肿瘤。结论对于PSA升高、前列腺穿刺活检阴性的前列腺增生患者，可以考虑应用等离子体行经尿道前列腺外周带切除术。
Abstract:
ObjectiveTo investigate the feasibility of applying plasma kinetic transurethral resection of the peripheral zone of the prostate in the diagnosis and management of patients with benign prostatic hyperplasia (BPH) presenting with elevated serum prostate specific antigen (PSA) and negative prostate biopsy findings.MethodsFrom January 2022 to June 2025, a total of 106 BPH patients with significant lower urinary tract obstructive symptoms, elevated serum PSA, and negative prostate biopsy results were enrolled. All the patients underwent plasma kinetic transurethral resection of the peripheral zone of the prostate. Initially, plasma kinetic enucleation of the prostatic adenoma was performed, and the enucleated tissue (central zone) was evacuated, followed by resection of the peripheral zone tissue. The resected tissues were separately submitted for pathological examinations.ResultsAll the 106 procedures were successfully completed. The mean operative time was (57.4±10.6) min, comprising (30.7±6.6) min for adenoma enucleation (central zone resection) and (26.6±8.0) min for peripheral zone resection. The mean intraoperative blood loss was (140.1±53.0) ml. Intraoperative perforation of the prostatic capsule occurred in 17 cases, and incision of the seminal vesicle was noted in 8 cases. Pathological diagnosis revealed benign prostatic hyperplasia in 77 cases, among which 8 were accompanied by highgrade prostatic intraepithelial neoplasia (PIN), located in the central zone in 2 cases and in the peripheral zone in 6 cases. Prostatic adenocarcinoma was identified in 29 cases, including 7 cases in the central zone (Gleason score ≤ 6 in 4 cases, and ≥ 7 in 3 cases), 19 cases in the peripheral zone (Gleason score ≤ 6 in 9 cases, and ≥ 7 in 10 cases), and 3 cases with tumor involvement in both peripheral and central zones (Gleason score 6 in 2 cases and 7 in 1 case). Postoperative followup ranged from 6 to 24 months, with a mean of 11.9 months. At 3 months postoperatively, serum PSA levels were < 0.01 μg/L in 64 patients, 0.01-0.2 μg/L in 32 patients, and 0.2-1.0 μg/L in 10 patients. Seven patients with prostate cancer underwent laparoscopic radical prostatectomy at 3 months postoperatively, and no residual tumor was identified pathologically.ConclusionFor BPH patients with elevated serum PSA and negative prostate biopsy findings, plasma kinetic transurethral resection of the peripheral zone of the prostate may be considered a viable diagnostic and therapeutic option.

参考文献/References:

[1]Bernardino RM,Yin LB,Lajkosz K,et al.Undetected cribriform and intraductal prostate cancer at biopsy is associated with adverse outcomes.Prostate Cancer Prostatic Dis,2025,28(1):187-192.
[2]Jiang X,Chen M,Tian J,et al.Comparison of regional saturation biopsy,targeted biopsy,and systematic biopsy in patients with prostatespecific antigen levels of 4-20 ng/ml:a prospective,singlecenter,randomized controlled trial.Eur Urol Oncol,2024,7(4):944-953.
[3]胡志凯,许露伟,桂赞龙,等.“诊断性”前列腺电切术在前列腺穿刺活检阴性伴下尿路症状患者中的应用.中华老年医学杂志,2017,36(2):166-168.
[4]Yamashiro JR,de Riese WTW.Any correlation between prostate volume and incidence of prostate cancer:a review of reported data for the last thirty years.Res Rep Urol,2021,13:749-757.
[5]Vo LT,Armany D,Chalasani V,et al.Endoscopic enucleation of the prostate versus transurethral resection of the prostate for benign prostatic hyperplasia:a systematic review and metaanalysis.Prostate Cancer Prostatic Dis，2025，28（4）：845-858.
[6]Baraban E,Epstein J.Prostate cancer:update on grading and reporting.Surg Pathol Clin,2022,15(4):579-589.
[7]Kawa SM,Stroomberg HV,Larsen SB,et al.A nationwide analysis of risk of prostate cancer diagnosis and mortality following an initial negative transrectal ultrasound biopsy with longterm followup.J Urol,2022,208(1):100-108.
[8]Tops SCM,Grootenhuis JGA,Derksen AM,et al.The effect of different types of prostate biopsy techniques on postbiopsy infectious complications.J Urol,2022,208(1):109-118.
[9]Hu JC,Assel M,Allaf ME,et al.Transperineal versus transrectal magnetic resonance imagingtargeted and systematic prostate biopsy to prevent infectious complications: the PREVENT randomized trial.Urol,2024,86(1):61-68.
[10]Li CX,Bhattacharya I,Vesal S,et al.ProstAtlasDiff:prostate cancer detection on MRI using Diffusion Probabilistic Models guided by population spatial cancer atlases.Med Image Anal,2025,101:103486.
[11]单玉喜.经尿道前列腺电切术在前列腺癌诊断治疗中的应用.现代泌尿生殖肿瘤杂志,2013,5(3):129-131.
[12]Morita M,Matsuura T.Management of localized prostate cancer by focal transurethral resection of prostate cancer:an application of radical TURPCa to focal therapy.Adv Urol,2012,2012:564372.
[13]SuazaMartínez LR,GarcíaValencia J,Gómez DE,et al.Risk factors for perioperative complications in transurethral prostate resection in patients at a Colombian institution.Arch Esp Urol,2021,74(8):752-761.

备注/Memo

备注/Memo:
基金项目：江苏省“科教兴卫”青年医学人才(QNRC2016794)**通讯作者，Email：fhust@163.com①(徐州医科大学附属医院泌尿外科，徐州221002)
更新日期/Last Update: 2026-06-22