前列腺癌并发双肾积水的治疗

Treatment of bilateral hydronephrosis caused by prostate cancer

目的 探讨前列腺癌并发双肾积水的治疗方法。方法 前列腺癌并发双肾积水患者24例，年龄64～81岁，平均71岁。均行雄激素全阻断治疗，其中手术去势加雄激素阻断剂（比卡鲁胺50mg／d）18例，药物去势（戈舍瑞林3．6mg／月）加比卡鲁胺6例。下尿路梗阻症状严重者19例，其中行留置导尿13例，行膀胱造瘘术6例。治疗3个月后观察患者前列腺体积、血清PSA值、肾积水及总肾功能的变化。结果 与治疗前比较，治疗3个月后经直肠超声测量前列腺体积由（70．3±11．2）ml降至（42．6±15．8）ml（P=0．001）；血清PSA值由（40．3±27．2）ng／ml降至（9．5±8．3）ng／ml（P=0．02）；IVU显示双肾积水改善者18例，无明显变化者3例，积水加重者3例；14例肾功能不全者血尿素氮由（12．8±6．5）mmol／L降至（6．3±4．2）mmol／L（P=O．004），血肌酐由（206．8±152．3）μmol／L降至（85．3±43．6）μmol／L（P=O．03）。肾积水无明显变化或加重者6例中，4例行经皮肾穿刺造瘘术，2例行输尿管皮肤造瘘术。结论 雄激素全阻断结合留置导尿或膀胱造瘘是治疗前列腺癌并发双肾积水的有效方法。

Objective To evaluate the treatment of bilateral hydronephrosis caused by prostate cancer. Methods Twenty-four cases with mean age of 71 years old （ranging from 64-81 years old） were diagnosed with bilateral hydronephrosis caused by prostate cancer and treated with complete androgen deprivation. Surgical castration plus Bicalutamide 50 mg/d was offered to 18 cases and medical castration （Goserelin, 3.6 mg/month） plus Bicalutamide 50 mg/d was offered to 6 cases. There were 19 cases developed severe lower urinary tract symptoms. Among these 19 cases, 13 cases had accepted Foley catheter and 6 cases accepted suprapubic tube drainage. Results Before and after the treatment, the prostate volume decreased from （70.3±11.2） ml to （42.6±15.8） ml （P = 0. 001 ）. Total PSA decreased from （40. 3±27.2）ng/ml to （9.5±8.3）ng/ml（P=0.02）. Of the 24 cases, hydrone-phrosis improved in 18 cases, remained unchanged in 3 cases and deteriorated in 3 cases. There were 14 patients developed renal insufficiency. After the treatment, Serum urea nitrogen decreased from （12.8±6. 5）mmol/L to （6. 3±4. 2）mmol/L（P=0. 004） and serum creatinine decreased from （206.8±152.3）μmol/L to （85.3±43.6）μmol/L（P=0.03）, respectively. For those 6 cases with hydronephrosis unchanged or deteriorated during the treatment, 4 cases accepted percutaneous nephrostomy and 2 cases accepted chtaneous ureterostomy. Conclusion The combination of complete androgen deprivation and bladder drainage through Foley catheter or suprapubic tube is an effective option in the treatment of bilateral hydronephrosis caused by prostate cancer.