前列腺囊腺瘤诊疗策略分析及20年单中心病例回顾  

Analysis of diagnostic and treatment strategies for cystadenoma of the prostate and a 20-year single-center case review

作　　者：李祥 陈旭 虞巍[2] 谌诚[2] LI Xiang;CHEN Xu;YU Wei;SHEN Cheng(Department of Urology,Ulanqab Hospital of Traditional Chinese Medicine and Mongolian Medicine,Ulanqab,Inner Mongolia,012000,China;Department of Urology,Peking University First Hospital)

机构地区：[1]乌兰察布市中医蒙医医院泌尿外科,内蒙古自治区乌兰察布012000 [2]北京大学第一医院泌尿外科

出　　处：《临床泌尿外科杂志》2024年第1期46-53,共8页Journal of Clinical Urology

摘　　要：目的:探讨前列腺囊腺瘤临床特点及治疗。方法:报告4例前列腺囊腺瘤的诊疗经过,并检索中国知网、万方数据库、维普数据库、Pubmed、Medline、Web of Science数据库,收集前列腺囊腺瘤的病例报告,与北京大学第一医院病例汇总分析。结果:共纳入65例患者,前列腺囊腺瘤患者发病年龄14~81岁,以“排尿困难、尿频、尿潴留”等下尿路梗阻症状为首发表现的患者占比最高,达76.9%(50/65)。63.8%(30/47)的患者前列腺特异性抗原(prostate-specific antigen,PSA)水平会出现异常,CA19-9及PSA水平的升高能为该病的诊断提供一定的支持依据。影像学表现为位于膀胱与直肠之间的体积较大的多房性强化的囊实性肿物。37例患者接受了完整的肿瘤切除,2例患者出现了复发,复发率约为5.4%,而接受经尿道手术的患者其复发率高达80%(8/10),囊肿部分切除术的复发率亦高达75%(6/8),囊肿穿刺抽液患者共3例,术后不同时间均出现复发。2例患者接受了内分泌治疗,其中1例控制良好,另外1例出现复发。8例患者进行了肿瘤及前列腺的一并切除,1例患者进行了全盆腔脏器切除,均未见复发。还有5例患者接受了根治性膀胱全切+尿流改道术,术后1例患者出现复发。4例接受开放肿物切除的患者出现了意外损伤直肠的并发症,2例出现了膀胱受损的并发症。结论:前列腺囊腺瘤的最主要临床表现为下尿路梗阻症状,影像学表现为体积较大的多房性囊实性肿物,肿物完整切除术是最有效治疗方法,机器人辅助腹腔镜及腹腔镜手术具有视野更好的优势,可能降低周围器官的副损伤。Objective To investigate the clinical features and treatment of prostatic cystadenoma.Methods We report the diagnosis and treatment of 4 cases of prostatic cystadenoma,and searched CNKI,Wanfang,VIP,Pubmed,Medline,and Web of Science databases to collect case reports of prostatic cystadenoma.The data were summarized and analyzed with the cases in Peking University First Hospital.Results A total of 65 patients were included.The age of prostatic cystadenoma patients ranged from 14 to 81 years old,and the highest proportion of patients(76.9%,50/65)presented with lower urinary tract obstruction symptoms,such as difficulty in urination,urinary frequency,and urinary retention,etc.Abnormal prostate-specific antigen(PSA)levels were shown in 63.8%(30/47)of the patients,and elevated CA19-9 and PSA levels could be used to diagnose this disease.Imaging showed a large cystic solid mass with multilocular enhancement between the bladder and the rectum.Thirty-seven patients underwent complete resection of the tumor,and 2 patients had recurrence,with a recurrence rate of about 5.4%.The recurrence rate was as high as 80%(8/10)in patients who underwent transurethral surgery,and 75%(6/8)in those who underwent partial resection of cysts.Three patients with cyst aspiration had recurrence of the tumor at different times.Two patients underwent androgen deprivation therapy,one of which was well controlled and the other had a recurrence.Eight patients who underwent combined resection of the tumor and prostate,and 1 patient who underwent total pelvic organ resection didn't recur.Other five patients underwent radical total cystectomy+urinary diversion,but one of them experienced recurrence after surgery.Four patients who underwent open mass resection experienced complications of accidental injury to the rectum,and two experienced complications of bladder damage.Conclusion The predominant clinical manifestations of prostatic cystadenoma are symptoms of lower urinary tract obstruction.Imaging examinations show large,multilocular,cystic solid ma

关 键 词：前列腺囊腺瘤 诊断 治疗 临床特点 

分 类 号：R737.25[医药卫生—肿瘤]