摘要
目的探讨经尿道汽化切除术（TUVRP）或经尿道电切术（TURP）治疗伴膀胱出口梗阻（BOO）的晚期前列腺癌（PCa）的临床疗效。方法伴BOO症状的PCa患者96例,年龄61～92岁,平均75岁。经影像学和前列腺穿刺活检诊断为T3～T4 PCa且经睾丸切除和抗雄激素或放射治疗后仍有排尿困难者75例,有梗阻症状但穿刺活检报告为良性前列腺增生（BPH）或非典型性增生21例。术前确诊为PCa患者采用姑息性TUVRP。术前未明确PCa者按BPH切除,7例术中冷冻切片明确PCa,同时行睾丸切除术,14例术后病理确诊后行睾丸切除术。结果96例患者TUVRP或TURP平均时间（47±11）min,切除前列腺平均重量（26．3±7．2）g。术后并发症包括：拔除导尿管后不能自主排尿18例、急性附睾炎8例、暂时性尿失禁5例、肉眼血尿10例。术后随访15～72个月,平均41个月。失访12例（12．5％）。死于PCa 18例（18．8％）,平均生存37个月。死于其他原因7例。患者术后排尿梗阻症状明显改善,国际前列腺症状评分（IPSS）术前平均29．2±3．5,术后3个月时降至8．1±2．4（P＜0．001）；最大尿流率（Q（max））术前平均（6．8±3．1）ml/s,术后6个月时（15．7±3．1）ml/s（P＜0．05）；PSA术前（84．6±45．1）ng/ml,术后6个月时降为（13．2±12．5）ng/ml（P＜0．05）。7例患者随访期间出现梗阻症状再次电切。存活59例已随访17～96个月,有骨转移31例。结论TUVRP是治疗伴BOO的晚期PCa的安全、有效方法,可迅速缓解梗阻症状,提高患者生活质量。
To evaluate the clinical value of the transurethral vapor-resection of the prostate （TUVRP） for bladder outlet obstruction （BOO） in patients with advanced prostate cancer （PCa）. Methods Of 96 patients with BOO （mean age, 75 years; age range, 61- 92 years）, 75 were definitely diagnosed with advanced PCa （stage T3 - T4 ） by imaging study and biopsy, and after treatment with orchectomy, anti-androgen or radiation they still had symptoms of BOO; 21 cases were diagnosed with benign prostate hyperplasia （BPH） or atypical hyperplasia. All patients underwent TUVRP for BOO at 1 or 2 stages. Results The mean operative time of initial TUVRP was （47-4-11） rain. The mean weight of resected tissues was （26. 3-4-7. 2） g. Postoperative complications included dysuria in 18 cases,acute epididymitis in 8, transient urinary incontinence in 5, and gross hematuria in 10. Obstructive voiding symptoms were significantly improved during a mean follow-up of 41 months （range, 15-72 months）. Twelve cases （12.5%） were lost to follow-up; and 18 cases （18.8%） died of PCa, with a mean survival of 37 months. Seven cases died of other diseases. After treatment, IPSS decreased from 29.2-I-3.5 preoperatively to 8. 1 ± 2.4 three months postoperatively （P〈0. 001）. Qmax increased from （6.8±3.1） ml/s preoperatively to （15.7±3.1） ml/s 6 months postoperatively （P〈0.05）. PSA levels decreased from （84.6±45.1） ng/ml preoperatively to （13.2±12.5） ng/ml 6 months postoperadvely（P〈0.05）. BOO recurred in 7 cases; and they underwent TUVRP again. Bone metastasis was found in 31 cases. Conclusions TUVRP is safe and effective in relieving symptoms of BOO and improving quality of life in patients with advanced prostate cancer.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2007年第8期544-547,共4页
Chinese Journal of Urology
关键词
前列腺肿瘤
癌
膀胱出口梗阻
经尿道汽化切除手术
Prostatic neoplasms
Carcinoma
Bladder outlet obstruction
Transurethralvapor-resection
作者简介
通信作者：叶敏，Email：minyefanglu@163．com
