微创经尿道前列腺等离子电切术联合内分泌治疗高龄晚期前列腺癌合并尿潴留  

Minimally Invasive Transurethral Plasmakinetic Resection of Prostate Combined with Endocrine Therapy for Advanced Prostate Cancer with Urinary Retention in Elderly Patients

作　　者：刘定益 胡桑 楚晨龙[3] 周燕峰 何竑超[3] 王健 周文龙[3] 

机构地区：[1]上海浦南医院泌尿外科,上海200125 [2]上海邮电医院泌尿外科,上海200040 [3]上海交通大学附属瑞金医院泌尿外科,上海200025

出　　处：《中国微创外科杂志》2017年第10期919-921,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：上海浦东新区卫生系统重点学科建设资助(项目编号:PWZX 2014-19);上海浦东新区科技发展基金创新资助(项目编号:PKJ 2013-y33)

摘　　要：目的探讨微创经尿道前列腺等离子电切术联合手术去势或药物去势治疗高龄晚期前列腺癌合并尿潴留的疗效和安全性。方法 2010年8月~2015年8月采用微创经尿道前列腺等离子电切术联合手术去势或药物去势治疗合并尿潴留晚期前列腺癌38例,观察术前后国际前列腺症状评分(international prostate symptom score,IPSS)、生活质量评分(quality of life,QOL)、最大尿流率(Qmax)、血清前列腺特异性抗原(prostate specific antigen,PSA)变化和术后并发症。结果手术时间10~30 min,(18.9±5.7)min,术中和术后无输血,无前列腺电切综合征发生,拔除导尿管后均能自行排尿。术前IPSS中位数31分(30~35分),明显高于术后14分(10~21分)(Z=-7.548,P=0.000);术前QOL中位数6分(5~6分),明显高于术后1分(0~2分)(Z=-7.793,P=0.000);术前Qmax中位数2.3 ml/s(0~10.9 ml/s),明显低于术后15.8 ml/s(6.2~22.3ml/s)(Z=-7.154,P=0.000);术前PSA中位数50μg/L(8.5~500μg/L),明显高于术后PSA 0.2μg/L(0.01~9.3μg/L)(Z=-7.740,P=0.000)。结论微创经尿道前列腺等离子电切术联合手术去势或药物去势治疗合并尿潴留晚期前列腺癌安全、有效,可明显提高合并尿潴留晚期前列腺癌患者的生活质量。bObjective To investigate the efficacy and safety of minimally invasive transurethral plasmakinetic prostatectomy combined with endocrine therapy（ surgical castration or androgen blockade） for the treatment of advanced prostate cancer with urinary retention in elderly patients. Methods From August 2010 to August 2015, minimally invasive transurethral plasmakinetic prostatectomy combined with endocrine therapy was performed in 38 patients,who were diagnosed as advanced prostate cancer with urinary retention. The changes of international prostate symptom score（ IPSS）,quality of life（ QOL）,maximum urinary flow rate（ Qmax）,prostate specific antigen（ PSA） and surgical related complications were reviewed. Results The mean operative time was（ 18. 9 ± 5. 7） min（ range,10 ~ 30 min）. No severe surgical related complications were observed. None of them needed perioperative blood transfusion and no transurethral resection syndrome was observed. Urinary catheter or cystostomy drainage was successfully removed after surgery in all the 38 cases. The preoperative IPSS was significantly higher than postoperative IPSS [median： 31（ 30-35） points vs. 14（ 10-21） points,Z =-7. 548,P = 0. 000]. The preoperative QOL was significantly higher than postoperative QOL [median： 6（ 5-6） points vs. 1（ 0-2） points,Z =-7. 793,P = 0. 000]. The preoperative Qmax was significantly lower than postoperative Qmax [median： 2. 3（ 0-10. 9） ml/s vs. 15. 8（ 6. 2-22. 3） ml/s,Z =-7. 154,P = 0. 000]. The preoperative PSA level was significantly higher than postoperative PSA level [median： 50（ 8. 5-500） μg/L vs. 0. 2（ 0. 01-9. 3） μg/L,Z =-7. 740,P = 0. 000]. Conclusions Minimally invasive transurethral plasmakinetic prostatectomy combined with endocrine therapy is effective and safe for advanced prostate cancer with urinary retention in elderly patients. This method can significantly improve the quality of life.

关 键 词：前列腺癌 尿潴留 经尿道前列腺等离子电切术 内分泌治疗 

分 类 号：R737.25[医药卫生—肿瘤]