经尿道等离子电切联合内分泌治疗晚期前列腺癌导致下尿路梗阻的临床疗效

Transurethral plasmakinetic prostatectomy combined with hormone therapy for lower urinary tract obstruction caused by advanced prostate cancer

目的探讨晚期前列腺癌致下尿路梗阻的治疗方法。方法 29例患者均采用"通道法"经尿道等离子前列腺电切加睾丸白膜下切除术,术后1周开始应用氟他胺0.25g,每天3次口服,3个月后复查PSA,PSA<2ng/ml时,再服药1个月后停药,以后每个月复查PSA,PSA>4ng/ml时又重新开始治疗。结果所有患者术后1个月国际前列腺症状评分(IPSS)降至9.0±1.1分,最大尿流率(Qmax)上升为17.6±2.4ml/s,膀胱残余尿量约为40±20ml。术后3个月19例PSA<2ng/ml,另外10例降到术前的10%。PSA、IPSS、Qmax及膀胱残余尿量均较术前有明显改善(P<0.05),随访5年26例患者仍健在。结论 "通道法"经尿道等离子前列腺电切联合内分泌治疗可有效解除下尿路梗阻,提高患者生活质量。

Objective To evaluate efficacy of the treatment of lower urinary tract obstruction caused by advanced prostate cancer. Methods 29 patients underwent transurethral plasmakinetic prostatectomy and bilateral orchiectomy under albuginea, one week later, each patient was treated by Flutamide 0.25 g o- rally 3 times a day. PSA was detected 3 months after the operation, when PSA 〈 2 ng/ml, Flutamide was continued for another month and then withdrawed, PSA was checked each month, when PSA〉4 ng/ml, Flu- tamide was given once more. Results All the patients＇interuational prostate symptom score （IPSS） de- creased to 9.0±1.1 one month postoperatively, maximum flow rate （Qmax） increased to17.6±2.4 ml/s, resid- ual urine volume is about 40±ml. Three months later, PSA level was less than 2 ng/mL in 19 cases, and decreased another 10 cases by 90% compared to preoperatively. PSA, IPSS, Qmax and residual urine vol- ume were also significantly improved （P 〈0.05）. 26 patients were still alive at 5 years＇ follow-up. Conclu- sion Transurethral plasmakinetic prostateetomy can relieve the lower urinary tract obstruction, bilateral or- chiectomy under albuginea relieve the psychological pressure, intermittent hormone therapy can eliminate the side effect of drugs, delay the occurrence of androgen-independent. It is important at grassroots ＇work.