姑息性经尿道前列腺切除术后局限性前列腺腺癌老年患者的康复观察  

Observation on rehabilitation of elderly patients with localized prostate adenocarcinoma after palliative transurethral resection of prostate

作　　者：张旭[1] 谢平[1] 夏圻儿[1] 徐杰 黄莺[1] Zhang Xu;Xie Ping;Xia Qier;Xu Jie;Huang Ying(Deparetment of Urology,Pudong New Area People′s Hospital,shanghai 201299,China)

机构地区：[1]上海市浦东新区人民医院泌尿外科,201299

出　　处：《中国药物与临床》2020年第15期2481-2486,共6页Chinese Remedies & Clinics

基　　金：上海市卫生健康委员会面上项目(201640386)。

摘　　要：目的了解局限性前列腺腺癌合并前列腺增生的老年患者行姑息性经尿道前列腺切除术及间歇性最大限度雄激素阻断药物治疗后1年的康复情况。方法前瞻性病例对照研究2015年3月至2019年3月我院因尿潴留入院、化验血清前列腺特异性抗原(PSA)升高的30例71~91岁患者,经前列腺磁共振成像(MRI)、经直肠超声引导下经会阴前列腺穿刺活检,诊断为T1~T2期局限性前列腺腺癌合并前列腺增生(A组15例)、良性前列腺增生(B组15例)。A组患者因各种原因不行根治术,施行姑息性经尿道前列腺切除术,术后辅助间歇性最大限度雄激素阻断药物治疗。B组行经尿道前列腺切除术。2组均为经会阴前列腺穿刺活检术后1周施行手术治疗,术后随访1年。结果2组术后均排尿通畅,无膀胱血块填塞导致再次手术止血,无持续性尿失禁、尿潴留、排尿困难。手术时间、术中出血量、术后留置导尿时间2组间差异无统计学意义(P>0.05)。术后1、2、3个月的尿红细胞计数、尿白细胞计数、最大尿流率、平均尿流率、残余尿量、血清肌酐2组间差异无统计学意义(P>0.05)。术后3、6、9、12个月血清肌酐、最大尿流率、平均尿流率、前列腺体积、残余尿量、国际前列腺症状评分(IPSS)评分、生活质量评分(QOL)评分2组间差异无统计学意义(P>0.05)。A组术后辅助最大限度雄激素阻断药物治疗时间3~12个月[平均(8.5±1.0)个月],血清PSA、血清睾酮均低于术前(P<0.05)。B组术后血清PSA均低于术前(P<0.05)。术后6、12月最大逼尿肌收缩力、Sch?覿fer列线图梗阻等级2组均低于术前(P<0.05),但两2组间差异无统计学意义(P>0.05)。A组1例、B组3例储尿期膀胱逼尿肌不稳定持续存在。2组术后前列腺MRI均未见明显异常。结论对于局限性前列腺腺癌合并前列腺增生的老年患者,经会阴前列腺穿刺活检术后1周施行姑息性经尿道前列腺切除术,�Objective To investigate the rehabilitation of the elderly patients with localized prostate adenocarcinoma with benign prostatic hyperplasia(BPH)for a year after palliative transurethral resection of prostate(pTURP).Methods A prospective case-controlstudy was conducted in 30 patients aged 71~91 years admitted to our hospital for urinary retention and serum PSA elevation from March 2015 to March 2019.MRI and transrectal ultrasound guided transperineal prostate biopsy were performed to diagnose stage T1-T2 localized prostate adenocarcinoma with BPH(group A,15 cases)and BPH(group B,15 cases).Because of various reasons,the patients of group A did not have radical prostatectomy.They chose pTURP and intermittent maximum androgen blocking(MAB)drug therapy.The patient of group B underwent TURP.The two groups were treated by operation a week after biopsy.Then follow-up a year.T test was used to compare the measurement data,P<0.05 was statistically significant.Results The patients got normal urination postoperatively in both groups,and there was no persistent urinary incontinence.There was no significant difference between the two groups in operation time,intraoperative bleeding volume and postoperative indwelling catheterization time.There was no significant difference between the two groups in urinary red blood cell count,urinary white blood cell count,maximum urine flow rate(Qmax),average urine flow rate(Qave),post urinary voiding residual(PVR)volume and serum creatinine at 1,2 and 3 months after operation(P>0.05).There was no sig-nificant difference in serum creatinine,Qmax,Qave,prostate volume,PVR volume,IPSS score and QOL score be-tween the two groups at 3,6,9 and 12 months after operation(P>0.05).In group A,the treatment time of intermittent MAB was 3-12 months[mean(8.5±1.0)months].Serum PSA and testosterone in group A were lower than those preoperatively(P<0.05).Serum PSA in group B was lower than that of before operation(P<0.05).The maximum detrusor contractility and Schafer nomogram obstructive grade in both gro

关 键 词：老年人 男性 前列腺肿瘤 前列腺增生 经尿道前列腺切除术 最大限度雄激素阻断 

分 类 号：R737.25[医药卫生—肿瘤]