不同方式的睾丸切除术在进展期前列腺癌治疗中的疗效比较

Assessment of different orchiectomy for patients with advanced prostate cancer

目的比较保留附睾的睾丸切除术（A组）与传统睾丸切除术（B组）在进展期前列腺癌治疗中的疗效，探讨睾丸去势治疗的最佳选择方式。方法进展期前列腺癌60例，A、B组各30例。均在局麻下行单切口双侧睾丸切除术，术后第1天起口服非类固醇类雄激素阻断剂。分别于术前、术后1周及1、3、6、9、12个月，观察2组血清总睾酮、前列腺特异性抗原（PSA）变化；了解患者手术满意度等。结果去势术后12个月，A、B组血清睾酮平均水平分别为0．2nmol／L（95％置信区间0．1～0．9nmol／L）、0．3nmol／L（95％置信区间0．2～0．9nmol／L），均〈1．9nmol／L，2组均数比较，P〉0．05；A组PSA平均值0．22ng／ml，B组0．27ng／ml，2组均数比较，P〉0．05。问卷调查示A组满意度为96．7％（29／30），B组为53．3％（16／30）。结论2种睾丸切除术在进展期前列腺癌治疗中疗效无明显差异，但保留附睾的睾丸切除术、附睾成形术有助于满足患者的阴囊外观形态和心理需要。

Objective To compare epididymis-sparing orchiectomy （group A） with traditional orchiectomy （group B） in patients with advanced prostate cancer, and to evaluate which procedure is better. Methods A total of 60 cases of advanced prostate cancer patients were enrolled, with 30 cases in group A and 30 cases in group B. They were given oral anti-androgen from 1 day after castration. Serum level of testosterone and prostatic specific antigen （PSA） was detected before castration, and 1 week, 1,3,6, 9 and 12 months after castration. Patient satisfaction was also evaluated. Results On time point of 12 months after castration, the average level of serum testosterone was 0.2 nmol/L （95% confidence interval, 0.1 -0.9 nmol/L） in group A and 0.3 nmoL/L （95 % confidence interval, 0.2 - 0.9 nmol/L） in group B （ P 〉 0.05 ） ; the average value of PSA was 0.22 ng/ml in group A and 0.27 ng/ml in group B （ P 〉 0.05 ） ; patient satisfaction rate was 96.7% （29/30） in group A and 53.3% （16/30） in group B. Conclusions No significant difference of testosterone level and PSA is found between the 2 groups. However, epididymis-sparing orchiectomy meets the psychological needs better because it helps to maintain the appearance of the scrotum through epididymis preservation and epididymoplasty.