经尿道双极等离子前列腺电切术或α1A受体阻滞剂联合内分泌治疗晚期前列腺癌伴膀胱出口梗阻的疗效观察  

Transurethral bipolar plasma prostate resection or alpha 1A receptor blocker in combination with endocrine therapy for treatment of bladder outlet obstruction in patients with advanced prostate cancer

作　　者：杨晓亮[1] 张艳斌[1] 魏灿[1] 王伟[1] 席俊华[1] 应全胜 吴畏[1] 杨振兴 陈运 倪大伟 Yang Xiaoliang;Zhang Yanbin;Wei Can;Wang Wei;Xi Junhua;Ying Quansheng;Wu Wei;Yang Zhenxing;Chen Yun;Ni Dawei(Urological Department of Affiliated Hefei Hospital of Anhui Medical Universit)

机构地区：[1]安徽医科大学附属合肥医院泌尿外科,合肥230011

出　　处：《中华临床医师杂志（电子版）》2018年第3期142-147,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨经尿道双极等离子前列腺电切术(TUPKP)联合最大限度雄激素阻断(MAB)与α1A受体阻滞剂(α1A-b)联合MAB治疗晚期前列腺癌伴膀胱出口梗阻(BOO)的临床疗效和安全性。方法回顾性分析2010年11月至2017年1月间安徽医科大学附属合肥医院泌尿外科收治的52例晚期前列腺癌伴BOO的病例,其中TUPKP联合MAB组29例,α1A-b联合MAB组23例。采用t检验对比2组治疗前及治疗后3个月前列腺特异性抗原(PSA)、残余尿量(PVR)、生活质量评分(QOL)、国际前列腺症状评分(IPSS)、最大尿流率(Qmax)等指标差异,随访并评估比较2组患者1、3、5年生存率及总体生存率,生存分析应用Kaplan-Meier法,组间比较采取Log-Rank检验。结果治疗前TUPKP联合MAB组与α1A-b联合MAB组PSA、PVR、QOL、IPSS及Qmax分别为(37.94±25.58)μg/L vs(47.29±42.10)μg/L、(158.07±57.81)ml vs(151.17±55.70)ml、(5.10±0.82)分vs(5.26±0.81)分、(26.62±3.78)分vs(25.83±4.21)分、(6.50±1.63)ml/s vs(6.60±2.26)ml/s。治疗3个月后2组PSA、PVR、QOL、IPSS及Qmax分别为(2.86±2.16)μg/L vs(5.19±3.54)μg/L、(31.17±19.97)ml vs(92.48±42.62)ml、(1.48±0.87)分vs(4.00±1.04)分、(7.83±3.26)分vs(16.57±3.87)分、(18.27±4.47)ml/s vs(9.10±2.82)ml/s。TUPKP联合MAB组与α1A-b联合MAB组治疗后较治疗前PSA、PVR、QOL、IPSS均降低,Qmax升高,且差异均具有统计学意义(t=7.688、14.013、18.582、22.737、-14.058,P均<0.001;t=4.800、9.716、6.996、8.377、-7.096,P均<0.001)。治疗3个月后,TUPKP联合MAB组与α1A-b联合MAB组比较PSA、PVR、QOL、IPSS均降低,且差异均具有统计学意义(t=2.777,P=0.009;t=6.367,P<0.001;t=9.478,P<0.001;t=8.831,P<0.001),Qmax则升高,差异无统计学意义(t=-1.762,P=0.084)。TUPKP联合MAB组与α1A-b联合MAB组中位生存时间分别为57.24个月、56.46个月,2组患者1、3、5年生存率及总体生存率比较,差异无统计学意义(χ~2=0.012,P=0.915)。结论 TUPKP联合MAB与α1A-b联合MAB治疗晚期前列腺癌�Objective To investigate the clinical efficacy and safety of transurethral bipolar plasma prostate resection（TUPKP） combined with maximal androgen blockade（MAB） and alpha 1 A receptor blocker（α1 A-b） combined with MAB in the treatment of bladder outlet obstruction（BOO） in patients with advanced prostate cancer. Methods From November 2010 to January 2017, 52 advanced prostate cancer patients with BOO at the Urological Department of Affiliated Hefei Hospital of Anhui Medical University were retrospectively analyzed, including 29 patients who underwent TUPKP plus MAB and 23 patients who underwent α1 A-b treatment plus MAB. The t-test was used for comparison of prostate specific antigen（PSA）, postvoid residual urine volume（PVR）, quality of life score（QOL）, the International Prostate Symptom Score（IPSS）, maximum urinary flow rate（Qmax）, and other variables between the two groups before and 3 months after treatment. The 1-, 3-, and 5-year survival rates and overall survival rate were compared between the two groups. Survival analysis was performed by Kaplan-Meier method, and log-rank test was used for comparison between the groups. Results Before treatment, the PSA, PVR, QOL, IPSS, and Qmax in the TUPKP ＋MAB and 1 A-b ＋ MAB groups were（37.94±25.58） μg/L vs（47.29±42.10） μg/L,（158.07±57.81） mLvs（151.17±55.70） mL,（5.10±0.82） vs（5.26±0.81）,（26.62±3.78） vs（25.83±4.21）, and（6.50±1.63） mL/svs（6.60±2.26） mL/s, respectively. After 3 months of treatment, the PSA, PVR, QOL, IPSS, and Qmax in the two groups were（2.86±2.16） μg/L vs（5.19±3.54） μg/L,（31.17±19.97） mL vs（92.48±42.62） mL,（1.48±0.87） vs（4.00±1.04）,（7.83±3.26） vs（16.57±3.87）, and（18.27±4.47） mL/s vs（6.60±2.26） mL/s, respectively. After treatment, the PSA, PVR, QOL, and IPSS in the TUPKP ＋ MAB and 1 A-b ＋ MAB groups decreased significantly compared with the values before treatment, while the Qmax significantly increased, and

关 键 词：前列腺癌 膀胱出口梗阻 经尿道双极等离子电切术 Α1A受体阻滞剂 内分泌治疗 

分 类 号：R737.25[医药卫生—肿瘤]