经直肠高强度聚焦超声治疗局限性前列腺癌(附36例报告)

High-intensity focused ultrasound in treatment of localized prostate cancer(a clinical report of 36 cases)

目的总结经直肠高强度聚焦超声(high-intensity focused ultrasound,HIFU)治疗局限性前列腺癌的临床经验并评估其有效性及安全性。方法使用Sonablate-500聚焦超声系统对36例局限性前列腺癌患者进行治疗,观察患者治疗时耐受情况,监测治疗后3、6、12个月时的血清前列腺特异性抗原(PSA)、直肠指诊(DRE)、最大尿流率(Qmax)及经直肠前列腺B超情况,治疗后6～12个月行经直肠前列腺穿刺活检。结果平均手术操作时间41min(25～76min),平均术后住院时间3.4d(2～9d)。治疗后3、6、12个月时PSA与治疗前相比均明显降低(P<0.05),Qmax较治疗前均增加(P<0.05),前列腺体积较治疗前均缩小(P<0.05),DRE发现结节消失或减小的占77.8%(28/36),B超提示低回声结节消失或缩小的占83.3%(30/36)。治疗后3、6、12个月各项检查结果差异无统计学意义(P>0.05)。结论HIFU治疗前列腺癌具有微创、安全、痛苦少、效果好、恢复快和并发症少等优点,对于无法耐受根治性前列腺切除术的局限性前列腺癌患者可考虑行HIFU治疗。

Objective To summarize the experience and to investigate the safety and effectiveness of transrectal high-intensity focused ultrasound（HIFU） in treatment of localized prostate canc er. Methods The third-generation HIFU device called the Sonablate-500TM （Focus Surgery,Indianapolis,IN,USA） was used. 36 cases of localized prostate cancer, which accepted the treatment with H IFU device,were analyzed. PSA, digital rectal examination, Qmax and transrectal ultrasound were examined at 3,6 and 12 months after the treatment. Prostatic biospies were done during the 6th to 12th month after the treatment. Results The average operation time was 41 min（25-76min）. The average length of hospital stay after operation was 3.4 d（2 9 d）. At 3,6,12 months post-operation, PSA level, Qmax and prostate volume were all significantly lower comparied with the pre operation＇s （P〈0. 05）,and the tumour nodus of 77.8%（28/36） cases with digital rectal examination was disap pearance or decreased,and 73.3 % （30/36） cases the tumour nodus with transrectal ultrasound was disappeared or decreased. The difference of result among 3,6 and 12 months are not significant. Conclusions HIFU is a micro-invasive, safe, painless, effective, faster recovery and less complication treatment way for localized prostate cancer.