经直肠高强度聚焦超声系统治疗前列腺癌57例疗效分析

Transrectal High-intensity Focused Ultrasound with the Sonablate 500 for the Treatment of Prostate Cancer

目的:探讨经直肠高强度聚焦超声系统(HIFU)治疗PCa的疗效。方法:使用Sonablate500型经直肠HIFU治疗系统,对57例PCa患者进行HIFU治疗,其中局限性PCa27例,晚期PCa30例。在确定生化复发之前,对局限性PCa仅行经直肠HIFU治疗;对于晚期PCa,在行经直肠HIFU治疗的同时,联合应用内分泌治疗。结果:HIFU治疗平均手术操作时间为111(86～153)min,平均术后住院时间为3.2(2～18)d。平均随访时间18(6～30)个月。局限性PCaHIFU治疗后,生化检查阴性率(PSA(4.0μg/L)在治疗后的1、2、3年分别为86%、81%和79%。30例晚期PCa治疗平均8个月(3～24个月)后,26例血清PSA<4.0μg/L(其中20例血清PSA<0.5μg/L)、21例患者前列腺体积缩小>50%。治疗后6个月时与治疗前相比,前列腺体积缩小、PSA水平降低、Qmax增加及IPSS改善差异均有显著性(P<0.05)。HIFU治疗后无严重尿道直肠瘘、尿失禁等并发症发生。结论:经直肠HIFU治疗PCa,安全、有效,并发症少,近期疗效较好,是一种可选择的PCa微创治疗方法。

Objective： To evaluate the clinical effect of transrectal high-intensity focused ultrasound （ HIFU ） in the treatment of prostate cancer （PCa）. Methods ： A total of 57 PCa patients, 27 localized and 30 advanced, underwent transrectal HIFU with the Sonablate 500, the localized group treated by transrectal HIFU only, while the advanced group by transrectal HIFU combined with androgen ablation. Results ： For the HIFU treatment, the mean operating time, hospital stay and follow-up were 111 min （ ranging from 86 to 153 min）, 3.2 days （ranging from 2 to 18 days） and 18 months （ranging from 6 to 30 months）, respectively. The biochemical disease-free rates at 1, 2 and 3 years in the localized group were 86%, 81% and 79%, respectively. While in the advanced group, the serum prostate specific antigen （PSA） was 〈 4.0 μg/L in 26 cases （ 〈 0. 5 μg/L in 20） and the prostate volume decreased more than 50% in 21 cases after treated for an average of 8 months （ ranging from 3 to 24 months）. After transrectal HIFU prostate ablation, the prostate volume reduced, serum PSA lowered, Qmax raised and IPSS improved significantly （ P 〈 0. 05 ）. No serious complications occurred including severe urethrorectal fistula and incontinence. Conclusion： Transrectal HIFU is a safe, effective and minimally invasive therapy for patients with prostate cancer.