近距离治疗计划系统（TPS）在前列腺癌诊治中的应用
发布时间：2018-09-04 09:54
【摘要】：目的:1.探讨模板定位下经会阴前列腺投影超饱和穿刺(以下简称“前列腺投影穿刺”)在临床疑诊为前列腺癌(prostatic cancer,PCa)但首次活检阴性患者中的诊断价值,评价其有效性和安全性。2.探讨125I粒子前列腺植入近距离治疗去势抵抗性前列腺癌(castration resistant prostate cancer,CRPC)的临床疗效。3.探讨经会阴模板下前列腺饱和穿刺(transperineal template-guided prostate saturation biopsy,TTPSB)对勃起功能的影响。方法:1.将218例首次经会阴穿刺活检诊断为前列腺良性病变,但前列腺特异性抗原(prostate specific antigen,PSA)持续4.0μg/L 或直肠指检(digital rectal examination,DRE)及 MRI阳性,临床高度怀疑PCa患者纳入研究。按再次穿刺的方法不同分为投影穿刺组和饱和穿刺组。按不同前列腺体积(40ml、40-80ml、80ml)比较两组穿刺的阳性率以及术后肉眼血尿、发热、尿潴留和会阴不适(肿胀、出血)等并发症的发生率,并且使用ⅡEF-5(5-item version of the International Index of Erectile Function)对观察组穿刺前与穿刺后 1 月、3 月和6月的勃起功能进行比较。2.将2010年2月至2016年3月我院收治的31例CRPC患者根据治疗方案的不同分成两组,内分泌治疗组14例进行单纯内分泌治疗,近距离治疗组17例行超声引导下经会阴穿刺1251粒子植入联合内分泌治疗,比较两组患者术后PSA无进展生存时间、总生存时间和生活质量。3.前瞻性入组2013年6月至2015年10月间来我院行前列腺穿刺的患者,依据患者病情、耻骨的解剖条件和个人意愿等因素分为观察组(TTPSB)和对照组(传统经阴模板下前列腺穿刺)。为排除穿刺结果给患者带来的焦虑从而引起的勃起功能障碍(erectile dysfunction,ED),并且剔除中途退出试验、失访及使用改善性功能药物(如5-磷酸二酯酶抑制剂等)的患者,最终观察组和对照组分别有97例和84例穿刺结果为前列腺增生(benign prostatic hyperplasia,BPH)的患者纳入分析。采用ⅡEF-5对患者穿刺前以及穿刺后1月、3月和6月的勃起功能进行评估。结果1.投影穿刺组总体穿刺阳性率及前列腺体积80ml者的阳性率均显著高于饱和穿刺组(P=0.044;P==0.041)。投影穿刺组术后出现血尿、发热、尿潴留和会阴不适的概率比饱和穿刺组高,但差异均无统计学意义(P0.05)。前列腺投影穿刺前的ⅡEF-5评分的中位数为18.7,穿刺后1月的ⅡEF-5评分的中位数为17.3,与穿刺前相比差异有统计学意义(P0.05),但是穿刺后3月和6月的ⅡEF-5评分的中位数分别为18.2、18.5,与穿刺前相比差异均无统计学意义(P0.05)。2.近距离治疗组中位PSA无进展及总体生存时间分别为29(25～37)月和37(30～50)月,与内分泌治疗组的13(7～22)、18(14～24)月比较均有统计学差异(P0.05)。对于两组患者治疗后的生活质量,近距离治疗组患者的尿路症状在治疗后1月与内分泌治疗组相比有统计学差异并有临床相关恶化,但术后6月以后与内分泌治疗组相比无统计学意义且无临床相关恶化;并且近距离治疗组患者的生理功能、社会功能、总健康水平和一般躯体不适与内分泌治疗组相比有明显的提高。3.观察组和对照组患者穿刺前ⅡEF-5评分分别平均为19.1±4.5和19.7±4.3,两者比较无统计学差异(t=0.890,P=0.375);穿刺后1月两组患者的ⅡEF-5评分分别为17.4±4.8和18.2±4.5,与穿刺前相比均有统计学差异(P0.05),但是穿刺后3月和6月两组患者的ⅡEF-5评分与穿刺前相比均无统计学意义(P0.05),并且各时间段观察组和对照组相比也无统计学差异(P0.05)。结论1.对于首次穿刺阴性但高度怀疑PCa的患者,前列腺投影穿刺可以提高穿刺的阳性率,更加准确的定位PCa,且穿刺后并发症发生率无明显增加,可以成为前列腺穿刺活检安全可靠的方法。2.近距离治疗CRPC能有效延长患者生存期,并且在一定程度上提高患者的生活质量。3.TTPSB可能导致短暂性(术后1月)的ⅡEF-5评分降低,但是与传统模板定位下经会阴前列腺穿刺活检(transperineal template prostate biopsies,TTPB)相比,没有加重对勃起功能的影响,并且勃起功能在穿刺后3～6个月恢复到穿刺前水平。
[Abstract]:Objective: 1. To evaluate the diagnostic value and safety of template-guided transperineal prostate projection hypersaturation puncture (PCP) in patients with suspected prostate cancer (PCa) but negative for the first biopsy. 2. To evaluate the efficacy and safety of 125I seed prostate implantation in brachytherapy for castration resistance. Objective:To investigate the effect of transperineal template-guided prostate saturation biopsy (TTPSB) on erectile function in patients with prostate cancer (CRPC). Methods: 218 cases of benign prostate lesions were diagnosed by transperineal template-guided prostate saturation biopsy (TTPSB) for the first time. Patients with highly suspected PCa were included in the study. They were divided into projection puncture group and saturation puncture group according to the method of re-puncture. Sexual rate and incidence of postoperative complications such as naked eye hematuria, fever, urinary retention and episiorrhea (swelling, bleeding) were compared with those before puncture and 1, 3, and 6 months after puncture in the observation group by using 2 EF-5 (5-item version of the International Index of Erectile Function). Thirty-one patients with CRPC were divided into two groups according to different treatment schemes. 14 patients in endocrine therapy group were treated with endocrine therapy alone. 17 patients in brachytherapy group were treated with ultrasound-guided transperineal 1251 seed implantation combined with endocrine therapy. From June 2013 to October 2015, prostatic patients undergoing prostate biopsy in our hospital were divided into observation group (TTPSB) and control group (traditional transvaginal prostate biopsy) according to the patient's condition, pubic anatomical conditions and personal wishes. Patients with ile dysfunction, ED, and withdrawal from the trial, loss of visit and use of sex-improving drugs (e.g. 5-phosphodiesterase inhibitors) were excluded. 97 patients with benign prostatic hyperplasia (BPH) were included in the final observation group and 84 patients in the control group, respectively. Results 1. The overall positive rate of puncture and the positive rate of 80 ml prostate volume in the projection puncture group were significantly higher than those in the saturation puncture group (P = 0.044; P = 0.041). The median score of IIEF-5 before prostate projection puncture was 18.7, and that of IIEF-5 one month after puncture was 17.3, which was significantly different from that before puncture (P 0.05). However, the median scores of IIEF-5 at 3 months and 6 months after puncture were 18.2 and 18.5, respectively, which had no statistical difference compared with that before puncture. Significance (P 0.05). 2. The median PSA progression and overall survival time in the brachytherapy group were 29 (25-37) months and 37 (30-50) months, respectively, which were significantly different from those in the endocrine group at 13 (7-22) and 18 (14-24) months (P 0.05). Compared with the endocrine treatment group, there were statistical differences and clinical related deterioration, but there was no statistical significance and no clinical related deterioration between the endocrine treatment group and the endocrine treatment group after 6 months. The scores of the observation group and the control group were 19.1 (+ 4.5) and 19.7 (+ 4.3) respectively before puncture, and there was no significant difference between the two groups (t = 0.890, P = 0.375); the scores of the two groups were 17.4 (+ 4.8) and 18.2 (+ 4.5) one month after puncture, respectively, which were significantly different from those before puncture (P 0.05). There was no significant difference between pre-puncture and pre-puncture scores (P 0.05), and there was no significant difference between the observation group and the control group (P 0.05). Prostate biopsy can be a safe and reliable method. 2. Proximal treatment of CRPC can effectively prolong the survival of patients, and to a certain extent improve the quality of life. 3. TTPSB may lead to temporary (1 month after surgery) II EF-5 score decreased, but with the traditional template positioning transperineal prostate biopsy (tra) Compared with TTPB, TTPB did not aggravate the effect on erectile function, and erectile function returned to pre-puncture level 3-6 months after puncture.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.25
本文编号：2221736
[Abstract]:Objective: 1. To evaluate the diagnostic value and safety of template-guided transperineal prostate projection hypersaturation puncture (PCP) in patients with suspected prostate cancer (PCa) but negative for the first biopsy. 2. To evaluate the efficacy and safety of 125I seed prostate implantation in brachytherapy for castration resistance. Objective:To investigate the effect of transperineal template-guided prostate saturation biopsy (TTPSB) on erectile function in patients with prostate cancer (CRPC). Methods: 218 cases of benign prostate lesions were diagnosed by transperineal template-guided prostate saturation biopsy (TTPSB) for the first time. Patients with highly suspected PCa were included in the study. They were divided into projection puncture group and saturation puncture group according to the method of re-puncture. Sexual rate and incidence of postoperative complications such as naked eye hematuria, fever, urinary retention and episiorrhea (swelling, bleeding) were compared with those before puncture and 1, 3, and 6 months after puncture in the observation group by using 2 EF-5 (5-item version of the International Index of Erectile Function). Thirty-one patients with CRPC were divided into two groups according to different treatment schemes. 14 patients in endocrine therapy group were treated with endocrine therapy alone. 17 patients in brachytherapy group were treated with ultrasound-guided transperineal 1251 seed implantation combined with endocrine therapy. From June 2013 to October 2015, prostatic patients undergoing prostate biopsy in our hospital were divided into observation group (TTPSB) and control group (traditional transvaginal prostate biopsy) according to the patient's condition, pubic anatomical conditions and personal wishes. Patients with ile dysfunction, ED, and withdrawal from the trial, loss of visit and use of sex-improving drugs (e.g. 5-phosphodiesterase inhibitors) were excluded. 97 patients with benign prostatic hyperplasia (BPH) were included in the final observation group and 84 patients in the control group, respectively. Results 1. The overall positive rate of puncture and the positive rate of 80 ml prostate volume in the projection puncture group were significantly higher than those in the saturation puncture group (P = 0.044; P = 0.041). The median score of IIEF-5 before prostate projection puncture was 18.7, and that of IIEF-5 one month after puncture was 17.3, which was significantly different from that before puncture (P 0.05). However, the median scores of IIEF-5 at 3 months and 6 months after puncture were 18.2 and 18.5, respectively, which had no statistical difference compared with that before puncture. Significance (P 0.05). 2. The median PSA progression and overall survival time in the brachytherapy group were 29 (25-37) months and 37 (30-50) months, respectively, which were significantly different from those in the endocrine group at 13 (7-22) and 18 (14-24) months (P 0.05). Compared with the endocrine treatment group, there were statistical differences and clinical related deterioration, but there was no statistical significance and no clinical related deterioration between the endocrine treatment group and the endocrine treatment group after 6 months. The scores of the observation group and the control group were 19.1 (+ 4.5) and 19.7 (+ 4.3) respectively before puncture, and there was no significant difference between the two groups (t = 0.890, P = 0.375); the scores of the two groups were 17.4 (+ 4.8) and 18.2 (+ 4.5) one month after puncture, respectively, which were significantly different from those before puncture (P 0.05). There was no significant difference between pre-puncture and pre-puncture scores (P 0.05), and there was no significant difference between the observation group and the control group (P 0.05). Prostate biopsy can be a safe and reliable method. 2. Proximal treatment of CRPC can effectively prolong the survival of patients, and to a certain extent improve the quality of life. 3. TTPSB may lead to temporary (1 month after surgery) II EF-5 score decreased, but with the traditional template positioning transperineal prostate biopsy (tra) Compared with TTPB, TTPB did not aggravate the effect on erectile function, and erectile function returned to pre-puncture level 3-6 months after puncture.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.25
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