澳门特别行政区前列腺癌根治术的疗效观察(附54例报告)

Efficacy of Radical Prostatectomy in Macao SAR

目的随访总结澳门特区54例接受前列腺癌根治性手术患者的临床特点以及预后。方法 2000年11月至2006年11月,54例前列腺癌患者行耻骨后前列腺癌根治手术。年龄54～79岁,平均69.8岁。统计分析术前PSA水平,术后病理分期以及Gleason评分,手术时间、术中出血、术中以及术后并发症。随访3～75个月,平均25.2月。分析术后PSA变化,术后生化复发、局部复发、远处转移率以及死亡率。结果本组病例大部分属于局限性前列腺癌患者,术前血清PSA:0～4.0 ng/ml占16.7%,4.0～10 ng/ml占51.8%,10.1～20.0 ng/ml占24.1%,>20 ng/ml占7.4%;TNM分期:T1 a+1b占7.6%,T2a+2b占20.3%,T2c占38.9%,T3a占20.3%,>T3a仅占12.9%;Gleason评分:2～4分占9.5%,5～6分占41.5%,7分占30.2%,8～10分占18.8%。手术平均时间为216分钟,术中平均出血量为760毫升。术中并发症:大出血1例(1.9%),损伤直肠1例(1.9%),损伤闭孔神经1例(1.9%)。早期术后并发症:尿失禁14例(25.9%),排尿困难5例(9.3%),急性尿潴留4例(7.4%),盆腔积液2例(3.8%),淋巴囊肿1例(1.9%),膀胱直肠瘘1例(1.9%)。晚期术后并发症:真性尿失禁或重度尿失禁6例(11.1%),急迫性尿失禁2例(3.8%),膀胱颈挛缩8例(14.8%)。术后总复发率为14.8%,其中仅有PSA升高5例(9.3%),发现局部复发和PSA升高1例(1.9%),远处转移和PSA升高2例(3.8%)。结论前列腺根治手术是治疗局限性前列腺癌安全有效的方法。

Objective To review and summarize the clinical features and prognosis of 54 cases of radical prostatectomy in Macao SAR.Methods From November 2000 to November 2006,54 prostate cancer patients, ranging from 54 to 79 years old(mean age 69.8 years old),underwent retropubic radical prostatectomy.Preoperative PSA level,postoperative pathologic grading and Gleason's score,operative time,blood loss and perioperative complications were statistically analyzed.Mean follow-up time was 25.2 months(3 months to 75 months).Postoperative parameters for evaluation include changes of PSA level,biochemical recurrence rate,regional recurrence,distant metastasis and mortality rate.Results Most of the patients had localized prostate cancer, the rate of their preoperative serum PSA were 16.7%(0～4.0 ng/ml),51.8%(4.0～10 ng/ml), 24.1%(10.1～20.0 ng/ml),and 7.4%(>20 ng/ml).As for TNM grading,7.6%of patients were in T1a + lbgroup,20.3%inT2a+2b,38.9%in T2c,20.3%in T3 a and only 12.9%were greater than T3a. Almost 10%of the candidates had 2-4 scores in Gleason' s scoring,41.5%with 5-6 scores,30.2%with 7 scores and 18.8%with 8-10 scores.Mean operative time was 216 minutes and mean blood loss was 760ml. One case of major hemorrhage(1.9%),one rectal injury(1.9%) and one obturator nerve injury(1.9%) were reported.Early postoperative complications were incontinence(14 cases,25.9%),bladder neck stricture (5 cases,9.3%),acute urinary retention(4 cases,7.4%),pelvic collection(2 cases,3.8%),lymphoeele (1 case,1.9%) and rectal-vesical fistula(1 case,1.9%).There were long-term complications found,namely as 6 cases of genuine urinary incontinence or severe urinary incontinence(11.1%),2 cases of urge incontinence (3.8%) and 8 cases of bladder neck contracture(14.8%).Recurrence rate was 14.8%with 5 cases (9.8%) of biochemical recurrence,1 regional recurrence(1.9%) and 2 distant metastasis(3.8%).Conclusions Radical prostatectomy is safe and effective for the treatment of localized prostate cancer.