本文關(guān)鍵詞：晚期前列腺癌行根治性切除術(shù)與內(nèi)分泌治療臨床效果的比較　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 晚期前列腺癌 內(nèi)分泌治療 前列腺癌根治性切除術(shù) 前列腺特異性抗原

【摘要】：前列腺癌是男性泌尿生殖系統(tǒng)最常見的惡性腫瘤之一,其癌癥死亡率僅次于支氣管肺癌和結(jié)直腸癌�？梢汕傲邢侔┑闹饕Y選方式是直腸指診和前列腺特異性抗原檢查,前列腺癌確診需要前列腺穿刺活檢的病理檢查。晚期前列腺癌的主要治療手段包括內(nèi)分泌治療、化療、放療及免疫治療,治療效果欠佳,部分患者可發(fā)展為去勢抵抗性前列腺癌,增加治療難度。前列腺癌根治性切除術(shù)作為晚期前列腺癌的減瘤手術(shù),目前缺乏治療有效的高級證據(jù),故診療指南尚未推薦對晚期前列腺癌患者行前列腺癌根治性切除術(shù)。由于理論、前期臨床試驗效果觀察及手術(shù)水平的提高,現(xiàn)在有必要進一步探討晚期前列腺癌根治性切除術(shù)的效果。目的:探討晚期前列腺癌患者行晚期前列腺癌行根治性切除術(shù)與內(nèi)分泌治療臨床效果,為晚期前列腺癌的手術(shù)治療提供理論依據(jù)。方法:回顧分析山東省立醫(yī)院泌尿微創(chuàng)中心2012年01月至2017年03月期間,確診為晚期前列腺癌,行內(nèi)分泌治療或者前列腺癌根治性切除術(shù),具有完整臨床資料的患者共135例,隨訪12個月,統(tǒng)計分析患者前列腺特異性抗原及睪酮的變化。運用SPSS 20.0軟件分析進行數(shù)據(jù)分析統(tǒng)計。計量資料以均數(shù)±標準差表示,用t檢驗或方差分析。分類資料進行卡方檢驗�？尚艆^(qū)間為95%,P0.05為差異具有統(tǒng)計學(xué)意義。結(jié)果：本研究納入晚期前列腺癌患者共計135例,行前列腺癌根治性切除術(shù)者70例,行內(nèi)分泌治療者65例。前列腺癌根治性切除術(shù)組的年齡、總前列腺特異性抗原、游離/總前列腺特異性抗原及堿性磷酸酶高于內(nèi)分泌組,兩者之間的差異存在統(tǒng)計學(xué)意義。前列腺癌根治性切除術(shù)患者術(shù)后第1月、3月、6月、12月總前列腺特異性抗原和游離前列腺特異性抗原較內(nèi)分泌治療組低,兩者的差異具有統(tǒng)計學(xué)意義,但是兩組患者的游離前列腺特異性抗原在第12月不存在統(tǒng)計學(xué)意義上的差異。前列腺癌根治性切除術(shù)后第1月、3月、6月、12月,血清總前列腺特異性抗原和游離前列腺特異性抗原降至正常水平的病例高于內(nèi)分組治療組。前列腺癌根治性切除術(shù)患者術(shù)后第1月、3月、6月、12月游離/總前列腺特異性抗原較內(nèi)分泌治療組低,但兩者的差異不具有統(tǒng)計學(xué)意義。前列腺癌根治性切除術(shù)后第3月、6月、12月,血清游離/總前列腺特異性抗原降至正常水平的病例高于內(nèi)分組治療組。前列腺癌根治性切除術(shù)患者術(shù)后第1月、3月、6月、12月睪酮較內(nèi)分泌治療組高,第1月、3月、6月兩者的差異具有統(tǒng)計學(xué)意義,第12月不存在統(tǒng)計學(xué)意義上的差異。結(jié)論:與內(nèi)分泌治療相比,前列腺癌根治性切除術(shù)可以短期內(nèi)降低晚期前列腺癌患者血清總前列腺特異性抗原、游離前列腺特異性抗原的水平,而兩者之間游離/總前列腺特異性抗原不存在明顯差異,同時睪酮降低水平不如內(nèi)分泌治療。此外,與內(nèi)分泌治療相比,前列腺癌根治性切除術(shù)可以將大部分患者的前列腺特異性抗原降至正常水平。
[Abstract]:Prostate cancer is one of the most common malignant tumor in male genitourinary system, the cancer mortality after lung cancer and colorectal cancer. The main way of screening of suspected prostate cancer is rectal examination and prostate-specific antigen examination, pathological examination of prostate cancer diagnosis requires a biopsy of the prostate. The main treatment of advanced prostate cancer include endocrine therapy. Chemotherapy, radiotherapy and immunotherapy, poor treatment, some patients may develop a castration resistant prostate cancer, increase the difficulty of treatment of prostate cancer. Radical resection as cytoreductive surgery for advanced prostate cancer, the current lack of effective treatment of advanced evidence, the guidelines do not recommend to patients with advanced prostate cancer prostate cancer after radical resection operation. Because of theory, the preliminary clinical trial results and improve the level of operation, it is necessary to further To investigate the effect of radical resection of advanced prostate cancer. Objective: To investigate the resection and clinical effect of endocrine therapy in patients with advanced prostate cancer patients with advanced prostate cancer who underwent radical surgery, and provide a theoretical basis for the treatment of advanced prostate cancer. Methods: Shangdong Province-owned Hospital minimally invasive urology center in 2012 01 to 2017 03 months were retrospectively analyzed during diagnosed late prostate cancer, endocrine therapy or prostate cancer radical resection, with complete clinical data of patients with a total of 135 cases were followed up for 12 months, changes in statistical analysis of patients with prostate specific antigen and testosterone. Analysis of data were analyzed by using SPSS 20 statistical software. Measurement data to mean + standard deviation, t test or analysis of variance. The classification data by chi square test. The confidence interval is 95% P0.05, the difference was statistically significant. Results: the study included the forefront of late A total of 135 cases of patients with adenocarcinoma of prostate cancer, radical resection in 70 cases, 65 cases underwent endocrine therapy. The age of radical resection group of prostate cancer, prostate specific antigen, free / total prostate-specific antigen and alkaline phosphatase was higher than that of endocrine group, statistically significant differences between the two. First months after radical resection, postoperative patients with prostate cancer in March, June, December, total prostate-specific antigen and free prostate-specific antigen with endocrine therapy group, the difference was statistically significant, but the two groups of patients with free prostate specific antigen in twelfth months there is no statistically significant difference in the cure. For first months after operation of prostate cancer in March, June, December, serum total prostate specific antigen and free prostate-specific antigen to normal levels were higher than in the group of prostate treatment group. Cancer resection patients first months after March, June, December free / total prostate-specific antigen is endocrine therapy group, but the difference was not statistically significant. Radical resection in third months after operation of prostate cancer in June, December, serum free / total prostate-specific antigen decreased to normal level in the group were higher than the treatment group. First months after radical resection, postoperative patients with prostate cancer in March, June, December is testosterone endocrine therapy group, first month, March, the difference was statistically significant between the twelfth month of June, there was no statistical difference significance. Conclusion: compared with endocrine therapy, resection short term operation can reduce the total serum prostate specific antigen in patients with advanced prostate cancer to cure prostate cancer, free prostate specific antigen levels, and between the two free / total prostate-specific antigen is not significantly different, At the same time, testosterone level is lower than endocrine therapy. In addition, compared with endocrine therapy, radical prostatic resection can reduce most patients' prostate specific antigen to normal level.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.25

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