经直肠超声引导氩氦靶向冷冻治疗前列腺癌23例疗效观察

Cryosurgical Ablation for 23 Cases of Prostate Cancer Guided by Rectal Ultrasound

目的:探索前列腺癌经皮冷冻治疗近期临床效果及并发症发生率。方法:使用ENDOCARE冷冻手术系统,经直肠超声引导,用2 mm冷冻刀经皮靶向冷冻前列腺癌,观察:①癌组织冷冻消融率;②并发症发生率;③手术前后PSA、PSMA的动态变化与疗效的关系。结果:①术后3周MR I显示:完全冷冻消融率34.8%(8/23);不完全冷冻消融率65.2%(15/23)。完全冷冻者术后6个月活检均呈阴性;未完全冷冻者活检阳性率为20%(3/15)。②术后轻度尿失禁发生率为13%(3/23),1月后均恢复正常。术后勃起功能障碍发生率为56.2%(9/16)。③氩氦刀治疗前后PSA水平分别为(32.98±35.50)μg/L、(11.65±26.51)μg/L,差异有统计学意义(P<0.05)。PSMA水平较术前上升显著。结论:经直肠超声引导经皮氩氦靶向冷冻治疗前列腺癌近期疗效满意,并发症少,创伤小。

Objective： To detect the short-term clinical and side effects of cryosurgical ablation for prostate cancer. Methods： The ENDOCARE cryosurgical system with 2 mm Cryo-probes was used to treat the prostate cancer guided by rectal ultrasonic.① Completeness of freeze ; ②Complications ; ③The changes of PSA and PSMA before and after operation were observed respectively. Results ：①The completeness of freeze rate and non-completeness of freeze rate were 34.8% （8/23） and 65.2% （15/23） showed by MRI 3 weeks later after operation ; The biopsy results showed that tumor positive rates in completeness of freeze group and non-completeness of freeze group were 0 and 20% （3/15） respectively after 6 months. ②The incontinence rate was 13% , and all recovered during 1 month; and the erectile dysfunction rate post-operation was 56.2% （9/16）. ③The levels of PSA before and after cryosurgical ablation were （32.98±35.50 ）μg/L, （ 11.65±26.51）μg/L respectively （P〈0.05 ）. PSMA increased significantly after the cryosurgical ablation. Conclusion ： The short-term curative effects of cryosurgical ablation, which guided by rectal ultrasound for prostate cancer is satisfied with low complication rate and minor vulnus.