目的 观察经会阴3D影像配准联合AI电磁导航下的mpMRI-TRUS影像融合活检在临床中的效果。 方法 回顾性地分析选取2022年1月至2024年2月于重庆医科大学附属永川医院接受前列腺穿刺活检的患者178例作为研究对象，根据穿刺方法的不同分为经直肠认知组及经会阴AI组，比较2种穿刺方式对有临床意义的前列腺癌（clinically significant prostate cancer，csPCa）检出率和并发症的差异，使用多变量Cox分析确定csPCa检出率的影响因素。 结果 94例患者和84例患者分别接受了经会阴AI融合和经直肠认知融合活检。在csPCa检测方面，经会阴AI融合活检优于经直肠认知融合活检（67.0% vs. 53.5%，P=0.048））。在多变量回归分析中，年龄、PI-RADS评分>3和经会阴穿刺途径是csPCa的显著预测因素。经会阴活检的尿潴留率高于经直肠活检（18.5% vs. 4.7%，P=0.009）。 结论 AI导航融合活检的csPCa检出率比经直肠认知融合活检更优。此外，经会阴活检发生感染并发症的风险较小。

Objective To investigate the clinical effect of mpMRI-TRUS image fusion biopsy under transperineal 3D image registration combined with AI electromagnetic navigation. Methods A retrospective analysis was performed for 178 patients who underwent prostate biopsy in Yongchuan Hospital Affiliated to Chongqing Medical University from January 2022 to February 2024，and according to the puncture method，they were divided into transrectal cognitive group and transperineal AI group. The two puncture methods were compared in terms of the detection rate of clinically significant prostate cancer（csPCa） and complications，and the multivariate Cox analysis was used to determine the influencing factors for the detection rate of csPCa. Results A total of 94 patients underwent transperineal AI fusion biopsy，and 84 patients underwent transrectal cognitive fusion biopsy. Transperineal AI fusion biopsy was superior to transrectal cognitive fusion biopsy in identifying csPCa（67.0% vs. 53.5%，P=0.048）. The multivariate regression analysis showed that age，PI-RADS score>3，and transperineal puncture were significant predictive factors of csPCa. Transperineal biopsy had a significantly higher urinary retention rate than with transrectal biopsy（18.5% vs. 4.7%，P=0.009）. Conclusion AI-guided fusion biopsy has a better detection rate of csPCa than transrectal cognitive fusion biopsy，and in addition，transperineal biopsy has a relatively low risk of infectious complications.