前列腺癌近距离治疗后下尿路症状变化的观察分析

Change in lower urinary tract symptoms after brachytherapy for prostate cancer

目的探讨前列腺癌近距离治疗后下尿路症状的变化发展规律，为临床治疗提供指导。方法接受近距离治疗的前列腺癌患者122例。年龄48-84岁，平均72岁。临床分期为T1cN0M0～T3N0M0治疗前PSA0．9～65．0ng／ml，Gleason评分5～9分，前列腺体积12～57ml。国际前列腺症状评分（IPSS评分）3～19分，平均12分。植入粒子30～86粒，活度11．1～19．6MBq，总活度444～1591MBq；植入针16～28根。术前2周至术后6个月常规使用α受体阻滞剂，术前1～6个月使用新辅助治疗106例（86．9％）。观察治疗后下尿路症状的变化。结果122例随访3～34个月，平均21个月。急性尿潴留8例（6．6％），保留尿管5～14d后拔除均可自行排尿；轻度尿失禁10例（8．2％），均在术后2～4个月好转。出现尿频、尿急及排尿困难或加重107例（87．7％）。术后0．5、1、2、3、6、9、12、15、18、21、24及30个月出现尿频、尿急及排尿困难或加重者分别为16．4％、80．3％、81．2％、74．6％、42．0％、25．2％、18．5％、11．5％、7．4％、2．5％、3．3％及0。下尿路症状持续时间与治疗前IPSS评分及前列腺体积成正相关，P值分别为0．012及0．003。结论前列腺癌近距离治疗后下尿路症状常见，持续时间较长，但不严重，均可恢复。持续时间与治疗前IPSS评分及前列腺体积相关。使用a受体阻滞剂及新辅助治疗可以有效缓解症状并避免手术干预。

Objective To evaluate the lower urinary tract symptoms （LUTS） after prostate cancer hrachytherapy. Methods 122 patients with prostate carcinoma underwent 12sI seed implanta tion. All patients were at clinical stage T1c N0M0 T3N0M0 with Gleason score 5 to 9, serum PSA 0. 9 65.0ng/ml, prostate volume 12 to 57ml. 30-86 seeds were implanted by 16 28 needles with seed activity 1.11-19.6 MBq mci, total seed activity 444 1591 MBq. International prostate symptom score （IPSS） ranged from 3 to 19, with mean of 12. All the patients received a-blocker and 106 cases（86.9%）received androgen deprivation therapy （ADT）. Results Patients were followed-up for 3-34 months （mean 21 months）. Acute urinary retention was found in 8 cases（6.6 %）and mild urina ry incontinence was found in 10 cases （8.2%）. During the follow-up, 107（87.7%）of them had LUTS or LUTS symptoms aggravated. Percentage of patients with LUTS after brachytherapy at different time point were as follow： 15 d, 16.4%; 1 month, 80.3% ; 2 months, 81.2% ; 3 months, 74.6% 6 months, 42.0% 9 months, 25.2%; 12 months, 18.5% 15 months, 11.5%;18 months, 7.4% 21 months, 2.5%; 24 months, 3.3% and 30 months, 0%. Larger prostate volume and higher IPSS before hrachytherapy were correlated with LUTS lasting time. Simple linear regression analyses re vealed prostate volume （r=0. 281, P=0. 003） and IPSS （r=0. 254, P=0. 012） before brachytherapy to be significant predictors of LUTS period respectively. Conclusion LUTS after prostate cancer brachytherapy is common and long lasting, but not serious, which could be relieved by a-blockers and ADT.