本文選題：經(jīng)尿道前列腺切除術(shù) + 前列腺腫瘤　； 參考：《北京大學學報(醫(yī)學版)》2015年04期

【摘要】：目的:評估晚期前列腺癌合并嚴重膀胱出口梗阻患者實施姑息性經(jīng)尿道前列腺切除術(shù)(palliative transurethral resection of the prostate,p TURP)的治療效果及預后。方法:回顧性分析北京大學第三醫(yī)院泌尿外科2007年11月至2015年1月所有實施p TURP的16例晚期前列腺癌膀胱出口梗阻患者,這16例患者的腫瘤分期為Ⅲ期或Ⅳ期,均伴嚴重膀胱出口梗阻癥狀(內(nèi)分泌治療后仍有尿潴留、大量殘余尿及合并上尿路積水)。收集患者臨床資料、圍手術(shù)期以及術(shù)后隨訪情況,并通過Kaplan-Meier分析計算病例的腫瘤特異生存率。結(jié)果:患者平均年齡73.8歲(63~81歲),其中前列腺癌Ⅲ期5例、Ⅳ期11例;手術(shù)指征為12例反復發(fā)生尿潴留,4例大量殘余尿伴尿路積水;手術(shù)前平均前列腺體積43.2 m L(28~78 m L),術(shù)前平均前列腺特異性抗原(prostatespecific antigen,PSA)48.2μg/L(ng/m L,2~107μg/L),殘余尿量166.4 m L(50~450 m L),術(shù)前平均尿流率為3.6 m L/s(0~6 m L/s,n=7)。手術(shù)時間62.9 min(35~94 min),出血量126.9 m L(30~263 m L),手術(shù)切除組織14.1 g(10~22 g),無輸血病例。術(shù)后PSA平均20.5μg/L(1~41μg/L),殘余尿量平均43.4 m L(0~400 m L),平均尿流率為10.1 m L/s(7~16 m L/s,n=7);1例出現(xiàn)術(shù)后持續(xù)血尿,保守治療后好轉(zhuǎn);術(shù)后6例患者延遲排尿,1例需長期留置膀胱造瘺管;2例患者進行二次手術(shù)切除。與術(shù)前相比,患者p TURP術(shù)后血清PSA下降(P0.001),殘余尿量減少(P0.001),平均尿流率增加(P=0.001)。平均隨訪時間36個月(1~86個月),3例患者死于前列腺癌的進展,患者p TURP術(shù)后2年、3年及5年腫瘤特異生存率分別為91%、78%、58%。結(jié)論:p TURP對緩解晚期前列腺癌患者膀胱出口梗阻有效,但組織切除量少、術(shù)后延遲排尿及二次手術(shù)率高,雖然不能完全排除手術(shù)對生存率的不良影響,但術(shù)后相對較高的腫瘤特異性生存率提示p TURP是一個可以選擇的術(shù)式。
[Abstract]:Objective: to evaluate the therapeutic effect and prognosis of patients with advanced prostate cancer complicated with severe bladder outlet obstruction by palliative transurethral prostatectomy (palliative transurethral resection of the prostatectomy). Methods: from November 2007 to January 2015, 16 patients with bladder outlet obstruction of advanced prostate cancer who were treated with pTURP in Urology Department, third Hospital of Peking University, were retrospectively analyzed. All patients were accompanied with severe bladder outlet obstruction (urinary retention, residual urine and hydrops of upper urinary tract after endocrine therapy). The clinical data, perioperative period and postoperative follow-up were collected, and the tumor-specific survival rate was calculated by Kaplan-Meier analysis. Results: the mean age of the patients was 73.8 years (63 / 81 years), including 5 cases of stage 鈪，

本文編號：2117107