经尿道等离子体前列腺切除联合抗雄治疗合并膀胱颈梗阻晚期高危前列腺癌

Transurethral resection of PKRP unity against androgen therapy prostate merger bladder neck obstruction high -risk prostate cancer late

目的探讨经尿道等离子体前列腺切除联合抗雄治疗合并膀胱颈梗阻晚期高危前列腺癌的临床意义。方法采用经尿道前列腺等离子切除术、去势术以及间歇雄激素阻断等综合方法治疗合并膀胱出口梗阻的晚期高危前列腺癌患者14例。结果所有手术均成功施行。术前及术后3个月复查尿动力学指标，患者最大尿流率由（8．0＋3．2）ml／s上升为（18．5±2．6）ml／s（P〈0．05），国际前列腺症状评分由术前的（29．0±3．1）降为（8．0±1．5）（P〈0．05），血清前列腺特异抗原由治疗前（51．3±19．4）ng／ml降至（8．8±6．1）ng／ml（P〈0．01），生活质量评分由治疗前（4．4±1．3）降至（2．3±0．5）（P〈0．05）。随访6个月至今，其中2例分别于术后14个月～18个月死于前列腺癌，1例术后22个月死于其他疾病，其余患者带瘤存活。结论合并膀胱出口梗阻的前列腺癌采用经尿道前列腺等离子切除术、去势术和间歇雄激素阻断的综合治疗具有创伤小、恢复快等优点，且能提高患者的生存质量并延长患者生存期。

Objectives Discussion PKRP joint androgen deprivation therapy high - risk merger bladder neck obstruction of the highly dangerous adanced prostate cancer clinical significance. Methods 14 cases of prostatic carcinoma complicated with bladder outlet obstruction were treated with bilateral orchidectomy combined with transurethral resection of the prostate plasma （PKRP） and intermittent male hormone blockage. Results All the operations succeeded. Preoperative and postoperative 3 months review urine dynamics index, Qmax increased from （8.0 ±3.2）ml/s to（ 18.5 ±2.6）ml/s（ p 〈 0.05）, IPSS decreased from（29.0 ±3.1）preoperatively to（8.0 ± 1. 5 ） postoperatively （ p 〈 0.05 ）, QOL decreased from （4.4 ± 1.3 ） to（ 2.3 ± 0.5 ） （ p 0.05 ）, PSA decreased from （ 51.3 ± 19.4） ng,/ml to（ 8.8 ± 6.1 ） ng/ml （ P 0. 01 ）. The follow up was 6months to today. 2 cases died of prostatic carcinoma and 1 cases died of other diseases. The others survived with carcinoma. Conclusions Combined therapy, which includes bilateral orchideetomy, PKRP and intermittent male hormone blockage, for prostatic carcinoma complicated with bladder outlet obstruction has advantages of minimal trauma and rapid recovery. It can prolong life span, improve the quality of life, and be worth of wide application.