晚期前列腺癌膀胱出口梗阻患者姑息性经尿道前列腺切除术疗效评价

发布时间：2018-07-12 12:09

  本文选题：经尿道前列腺切除术 + 前列腺肿瘤　； 参考：《北京大学学报(医学版)》2015年04期

【摘要】：目的:评估晚期前列腺癌合并严重膀胱出口梗阻患者实施姑息性经尿道前列腺切除术(palliative transurethral resection of the prostate,p TURP)的治疗效果及预后。方法:回顾性分析北京大学第三医院泌尿外科2007年11月至2015年1月所有实施p TURP的16例晚期前列腺癌膀胱出口梗阻患者,这16例患者的肿瘤分期为Ⅲ期或Ⅳ期,均伴严重膀胱出口梗阻症状(内分泌治疗后仍有尿潴留、大量残余尿及合并上尿路积水)。收集患者临床资料、围手术期以及术后随访情况,并通过Kaplan-Meier分析计算病例的肿瘤特异生存率。结果:患者平均年龄73.8岁(63~81岁),其中前列腺癌Ⅲ期5例、Ⅳ期11例;手术指征为12例反复发生尿潴留,4例大量残余尿伴尿路积水;手术前平均前列腺体积43.2 m L(28~78 m L),术前平均前列腺特异性抗原(prostatespecific antigen,PSA)48.2μg/L(ng/m L,2~107μg/L),残余尿量166.4 m L(50~450 m L),术前平均尿流率为3.6 m L/s(0~6 m L/s,n=7)。手术时间62.9 min(35~94 min),出血量126.9 m L(30~263 m L),手术切除组织14.1 g(10~22 g),无输血病例。术后PSA平均20.5μg/L(1~41μg/L),残余尿量平均43.4 m L(0~400 m L),平均尿流率为10.1 m L/s(7~16 m L/s,n=7);1例出现术后持续血尿,保守治疗后好转;术后6例患者延迟排尿,1例需长期留置膀胱造瘘管;2例患者进行二次手术切除。与术前相比,患者p TURP术后血清PSA下降(P0.001),残余尿量减少(P0.001),平均尿流率增加(P=0.001)。平均随访时间36个月(1~86个月),3例患者死于前列腺癌的进展,患者p TURP术后2年、3年及5年肿瘤特异生存率分别为91%、78%、58%。结论:p TURP对缓解晚期前列腺癌患者膀胱出口梗阻有效,但组织切除量少、术后延迟排尿及二次手术率高,虽然不能完全排除手术对生存率的不良影响,但术后相对较高的肿瘤特异性生存率提示p TURP是一个可以选择的术式。
[Abstract]:Objective: to evaluate the therapeutic effect and prognosis of patients with advanced prostate cancer complicated with severe bladder outlet obstruction by palliative transurethral prostatectomy (palliative transurethral resection of the prostatectomy). Methods: from November 2007 to January 2015, 16 patients with bladder outlet obstruction of advanced prostate cancer who were treated with pTURP in Urology Department, third Hospital of Peking University, were retrospectively analyzed. All patients were accompanied with severe bladder outlet obstruction (urinary retention, residual urine and hydrops of upper urinary tract after endocrine therapy). The clinical data, perioperative period and postoperative follow-up were collected, and the tumor-specific survival rate was calculated by Kaplan-Meier analysis. Results: the mean age of the patients was 73.8 years (63 / 81 years), including 5 cases of stage 鈪，

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