摘要
目的 研究前列腺尖部活检疼痛的发生机理及预防方法。方法出境观察尖部活检时穿刺针的进针位置，设计2种方法来降低疼痛程度。设立3个研究组，应用视觉模拟评分（VAs）尺评估应用不同镇痛方法进行前列腺尖部活检时患者的疼痛程度。对照组：10例，直接进行活检。肛管局麻组：10例，插入直肠探头前行肛管局部麻醉，1％利多卡因10ml从肛门口向肛管方向环绕腹侧半圈局部浸润麻醉肛管，然后再插入直肠超声探头进行活检。针刺痛觉测试组：15例，穿刺针轻轻接触直肠，以患者有无疼痛的自主感觉判断齿状线的位置（齿状线上方无痛觉，下方有痛觉），然后从齿状线的上方进针活检。3组患者均先行尖部活检，VAS评分结束后再行前列腺其他部位的活检。结果 观察尖部活检引起患者剧痛时的进针点，发现其位于齿状线以下的肛管。尖部活检3组的疼痛评分分别为：对照组4．46±1．24，肛管局麻组1．84±0．78，针刺痛觉测试组1．98±0．67（P〈0．05）；肛管局麻组麻醉时的疼痛评分为5．24±0．83，与对照组比较差异无统计学意义（P〉0．05）。对照组与肛管局麻组各有1例术后肛周疼痛，针刺痛觉测试组1例术后发热38．4℃。结论 前列腺尖部穿刺活检引起的疼痛主要由活检针刺穿齿状线以下的肛管皮肤引起。通过针刺痛觉测试从齿状线上方进针能显著减轻疼痛。肛管局部麻醉虽然能减轻活检时的疼痛，但由于麻醉本身即能引起患者明显疼痛，无益于改善患者整个穿刺过程的疼痛体验。
Objective To explore the causes of more frequently happened painful prostate biopsy at the prostatic apex rather than at other areas of the gland and develop maneuvers to avoid this painful apical prostate biopsy, Methods The prostate apical biopsy needle puncture sites in the rectum were recorded and accessed. Two maneuvers were developed to avoid the pain. There were 3 groups in this clinical trail. Ten patients in the control group were performed the apical biopsies routinely without any maneuver. Ten patients in the anal canal local anesthesia group were exposed to local anesthesia with 1% lidocaine injected into anal canal ventral hemicycle prior inserting the ultrasound probe, then the ultrasound guided apical biopsies were performed. Fifteen patients were assigned to the rectal pain sensation test group. In this group, the dentate line of anal canal was detected before the biopsy needle was aimed at apex and touched the rectal mucosa lightly. There would be no painful sensation if the puncture was above the dentate line and the painful sensation would he sharp if the puncture was below the dentate line. Then the apical biopsy was performed above the dentate line. All patients were offered apical prostate biopsies and then other areas of prostate would be biopsied. Patients were asked to score the visual analog scale （VAS） immediately after the prostate apical biopsy. Results The VAS score of apical biopsy in 3 groups were 4.46 ±1.24 in control group, 1.84 0.75 in anal canal local anesthesia group, 1.98±0.67 in rectal pain sensation test group （P〈0.05）, respectively. So, patient would have painful sensation if the prostate apical biopsy puncture site was below the rectal dentate line. The VAS score of patient was 5.24±0.83 at the time of applying the anal canal local anesthesia. There was no significant difference comparing to the control group （P〉0.05）. In thls study, there was 1 patient with crlssum pain after biopsy in control group and 1 patient in anal canal local anesthesia group, separately. 1 patient suffered high fever （38.4 ℃） in rectal pain sensation test group. Conclusions The prostate biopsy puncture site below or above the dentate line decides if it will be a painful prostate aplcal biopsy or not. We can significantly decrease the painful sensation by aim the puncture sites above the anal canal dentate line. The application of anal canal anesthesia can decrease pain score caused by prostate biopsy. However, this application itself can provoke obvious pain. So the application of anal canal anesthesia has llm ited role in patient＇s pain control during the prostate biopsy.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2008年第7期482-485,共4页
Chinese Journal of Urology
关键词
前列腺活检
疼痛控制
凿状线
Prostate blopsy
Pain control
Dentate line
