耻骨后根治性前列腺切除治疗淋巴结转移前列腺癌的疗效分析

发布时间：2018-01-28 13:59

本文关键词： 前列腺癌耻骨后根治性前列腺切除术淋巴结转移　出处：《中华男科学杂志》2017年11期 　论文类型：期刊论文

【摘要】：目的:探讨耻骨后根治性前列腺切除结合辅助内分泌治疗或局部外放疗治疗20例前列腺癌伴盆腔淋巴结转移的安全性和疗效。方法:术前对20例前列腺癌患者均行双侧足背淋巴管造影,对其中11例盆腔可疑淋巴结穿刺抽吸淋巴液,进行实时定量PCR(RT-PCR)检测淋巴液PSA mRNA和前列腺特异膜抗原(PSMA)mRNA的表达。20例均行耻骨后根治性前列腺切除和扩大盆腔淋巴结清扫,对其中3例切端阳性者待尿失禁控制后给予外放疗。结果:11例经RT-PCR检测淋巴结液PSA mRNA和PSMA mRNA阳性表达中均经病理证实为前列腺癌淋巴结转移。术中失血量中位数575 ml,术中输血5例。手术切缘阳性3例,漏尿和淋巴漏各2例,无尿失禁、血管损伤和直肠损伤病例。经中位数42个月随访,术后6~48个月生化复发12例,复发时间中位数12个月。术后12个月和48个月分别死亡2例。结论:术前淋巴管造影后穿刺抽吸淋巴结液,用RT-PCR方法检测淋巴液PSA mRNA和PSMA mRNA表达有助于术前确定前列腺癌盆腔淋巴结转移。采用耻骨后根治性前列腺切除和扩大淋巴结清扫结合辅助内分泌治疗,对切端阳性者给予局部外放射治疗是治疗前列腺癌伴盆腔淋巴结转移患者安全、有效的方法。但对Gleason 10分的盆腔淋巴结转移前列腺癌采用根治性前列腺切除应慎重。
[Abstract]:Objective: To investigate the effect of radical retropubic prostatectomy combined with adjuvant endocrine therapy or local radiotherapy in treatment of 20 cases of prostate cancer with pelvic lymph node metastasis. Methods: the efficacy and safety of preoperative 20 cases of prostate cancer patients underwent bilateral dorsal lymphangiography, of which 11 cases of pelvic lymph node aspiration suspicious lymph. Real time quantitative PCR (RT-PCR) mRNA and PSA lymph detection of prostate specific membrane antigen (PSMA) radical prostatectomy and extended pelvic lymph node dissection.20 expression cases of mRNA underwent retropubic, of which 3 cases were positive to control the cut end of urinary incontinence after radiotherapy. Results: 11 cases were detected by RT-PCR lymph PSA mRNA and PSMA mRNA solution node positive expression were pathologically confirmed prostate cancer lymph node metastasis. Intraoperative blood loss was 575 ml, 5 cases of intraoperative blood transfusion. Positive surgical margins in 3 cases, leakage of urine and lymphatic leakage in 2 cases, No incontinence, vascular injury and rectal injury cases. After a median follow-up of 42 months, 12 cases of biochemical recurrence after 6~48 months, the recurrence time was 12 months. After 12 months and 48 months respectively, 2 cases died. Conclusion: preoperative lymphography after aspiration of lymph fluid, have to determine the preoperative prostate cancer pelvic lymph node metastasis detected by RT-PCR PSA mRNA and PSMA mRNA expression in lymph. Radical prostatectomy and enlargement of lymph node dissection combined with adjuvant endocrine therapy by retropubic, on the cut end of positive local radiotherapy in the treatment is the treatment of prostate cancer with pelvic lymph node metastasis in patients with safe, effective the method of Gleason. But 10 points of pelvic lymph node metastasis of prostate cancer with radical prostatectomy should be careful.

【作者单位】：上海市浦南医院泌尿外科;上海邮电医院泌尿外科;上海交通大学附属瑞金医院泌尿外科;
【基金】：上海浦东新区科学技术委员会资助(PKJ-Y2013-33) 上海浦东新区卫生系统重点学科建设资助(PWZX 2014-19)~~
【分类号】：R737.25
【正文快照】： Supported by grants from Shanghai Pudong Commission of Science and Technology(PKJ-2013-y 33)and Key Disciplinary Construction Project of theHealth System of Pudong New District(PWZX 2014-19).Correspondence to:HU Sang,email:ydhysang@sina.comReceived:Janua

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