超声引导下经会阴冷冻治疗局限性前列腺癌

Transrectal ultrasound-guided transperineal cryosurgical ablation for localized prostate cancer

目的 总结超声引导下经会阴冷冻治疗局限性前列腺癌的安全性和近期疗效。方法伴严重并发症不能接受根治性手术或拒绝开放手术、预期寿命〈10年、前列腺体积≤40ml的局限性前列腺癌患者26例。经直肠B超引导下前列腺穿刺活检，证实为前列腺癌，Gleason评分2～4分6例、5～7分20例。血清PSA平均11．9（4．7～19．2）ng／ml。临床分期T1a-bN0M01例、T1cN0M010例、T2aN0M07例、T2bN0M04例、L2cN0M04例。均行超声引导下经会阴冷冻治疗，采用氩氦靶向双冷冻技术。观察其即刻和迟发并发症发生情况。术后2年内每3个月，以后每6个月复查PSA1次，PSA截止值≥0．5ng／ml认为治疗失败。患者术后6个月均建议行前列腺穿刺活检。结果26例平均手术时间（1024-32）min，均未输血。术后平均住院（6±2）d。拔除尿管后，控尿满意22例；4例尿失禁3～7d后恢复控尿；原有性功能者9例，术后出现勃起功能障碍5例；未发生尿潴留和尿道直肠瘘。26例随访平均22（6～30）个月，PSA〈0．5ng／ml23例，PSA≥0．5ng／ml3例；术后6个月前列腺穿刺活检20例，均为阴性。结论超声引导下经会阴冷冻治疗局限性前列腺癌安全有效，远期疗效尚需进一步观察后明确。

Objective To evaluate the safety and short-term efficacy of transrectal ultrasoundguided transperineal cryosurgical ablation（TRUSCSA） for localized prostate cancer. Methods The data of 26 patients who were diagnosed with clinically localized prostate cancer （T1aN0M0-T2cN0M0 ） by biopsy were reviewed. The data of serum prostate-specific antigen （PSA） level, clinical stage and Gleason score were collected. The Gleason score of all cases was 47; among them 6 cases were 2-4 and 20 cases were 5-7. The average pretreatment value of PSA was 11.9 ng/ml （4.7-19.2 ng/ml）. All the patients were treated with TRUSCSA, with a dual freeze-thaw cycle by using ultrathin 17- gauge cryoneedles. Immediate and delayed morbidities were evaluated. The PSA level was obtained every 3 months for the first 2 years and then every 6 months thereafter, and failure was defined as the inability to reach a nadir of 0.5 ng/ml or less. All patients were strongly encouraged to undergo routine biopsies despite a stable PSA level. Results The operative time was （102±32）min. The post- operative hospital stay was （6±2）d. After withdrawal of the catheter, 22 cases had good continence; 4 had temporary incontinence for 3-7 d. Before operation 9 cases had normal sex life, and among them 5 cases had erectile dysfunction after operation. No one developed urinary retention or urethrorectal fistula. The follow-up ranged from 6 to 30 months （mean 22）. The PSA level at the last follow-up visit was less than 0.5 ng/ml in 23 patients （88%） and 0.5 ng/ml or more in 3（12%）. Postoperative biopsies were taken in 20 cases and the results were negative at the 6th month. Conclusions Transrectal ultrasound-guided percutaneous cryosurgical ablation for clinically localized prostate cancer could be effective and safe. Additional studies with longer follow-up are necessary to determine the sustained efficacy of this procedure.