经尿道前列腺切除术治疗晚期激素非依赖性前列腺癌可行性分析

Transurethral resection of the prostate for advanced hormone-refractory prostate cancer:A feasibility study

目的:探讨经尿道前列腺切除术(TURP)在晚期前列腺癌并下尿路症状(LUTS)治疗中的作用。方法:对2004～2009年诊断为晚期前列腺癌合并LUTS的43例患者进行总结,分析TURP术前及术后3、12个月患者的IPSS评分、最大尿流率、以及疾病相关危险因素。结果:术后3个月,非雄激素依赖性前列腺癌患者的IPSS[(9.58±0.33)分]、最大尿流率[(8.96±0.47)ml/s]与术前[(19.60±0.41)分、(4.93±0.68)ml/s]存在显著差异(P<0.05)。随访12个月后IPSS[(15.73±0.66)分]、最大尿流率[(15.67±0.44)ml/s]与术前相比无显著性差异。多因素分析提示术前表现为急性尿潴留的患者术后预后相对较好,激素非依赖前列腺癌患者预后差。结论:TURP治疗晚期激素非依赖前列腺癌合并LUTS的患者,在短期内可以迅速降低IPSS评分,改善生活质量;远期效果不理想。同时,手术本身也可能带来相关并发症,降低患者生存质量。

Objective：To investigate the effect of transurethral resection of the prostate（TURP） in the treatment of advanced prostate cancer with bladder outlet obstruction（BOO）.Methods：We included in this study 43 cases of advanced prostate cancer with BOO treated by TURP,and analyzed their IPSS,maximum urinary flow rate and relevant risk factors pre-operatively and at 3 and 12 months after TURP.Results：Compared with the baseline,IPSS and the maximum urinary flow rate of the patients showed significant differences 3 months after surgery（[19.60±0.41] score vs [9.58±0.33] score,[4.93±0.68] ml/s vs [8.96±0.47] ml/s,P0.05）,but not at 12 months（[15.73±0.66] score,[5.67±0.44] ml/s）.In multiple regression analysis,a good outcome was associated with pre-operative acute urinary retention,while poor prognosis with hormone-refractory prostate cancer.Conclusion：In the treatment of advanced hormone-refractory prostate cancer with BOO,TURP can reduce IPSS and increase the maximum urinary flow rate in the early period after surgery,but its long-term effect is not so desirable.Meanwhile the operation itself may bring about relevant complications and reduce the patient＇s quality of life.