经直肠超声及^(125)I粒子植入治疗在前列腺癌患者中的应用

Application of transcrectal ultrasonography and I seeds implantation to prostate cancer

目的探讨经直肠超声引导下活检前列腺癌组织及植入125I粒子在前列腺癌诊断及治疗中的作用。方法治疗组前列腺癌患者49例,均经直肠超声引导下活检确诊,其中低危组28例,采用单纯经直肠超声引导下125I粒子植入治疗;高危组21例,采用经直肠超声引导下125I粒子植入治疗,术后口服内氟他胺内分泌化疗药物治疗。对照组20例行根治切除术。比较两组患者手术需要时长、住院时间、术后随访血清前列腺特异抗原(PSA)值变化及PSA无进展患者生存率的差异。结果所有患者手术过程顺利,治疗组平均手术时间1.4 h,术后平均住院时间5.8 d。49例患者平均植入粒子(57±12)粒。术后随访3~24个月。无因操作技术引起的严重并发症。45例粒子植入治疗前和治疗3个月后比较PSA水平明显降低,分别为(16.50±12.43)ng/mL和(0.67±0.28)ng/mL(P<0.05)。4例治疗后3个月血清PSA未降低,其中1例术后18个月发生骨转移,有2例在术后平均19.3个月出现PSA生化复发,2例于术后36个月死亡,累计PSA无进展患者生存率为89.8%。对照组中1例于术后21个月死亡,1例在术后14个月发生骨转移,1例在术后平均16个月出现PSA生化复发,累计PSA无进展患者生存率为85.0%。结论经直肠超声引导下穿刺活检及放射性125I粒子植入治疗前列腺癌是一种微创、安全有效、可行的方法。

Objective To explore the application of transcrectal ultrasonography guided biopsies and I seeds implantation in prostate cancer diagnosis and therapy.Methods A total of 49 prostate cancer patients with treatment group were recruited,both transrectal ultrasound-guided biopsy.28 patients with low-risk group underwent I transreetal brachytherapy guided by rectal ultrasound,21 patients with high-risk group were performed orehieetomy.Hormonal therapy with Bicalutamide was performed in all patients after operation.20 cases of control group were performed radical resection.Operation time,hospital stay,blood serum PSA and PSA progression free survival rate in each group were calculated and analyzed by statistic method.Results In treatment group,surgical procedure of all patients was well,operation time was 1.4 hour,and hospital stay was 5.8 d.The average number of I seeds used was（57±12）.The cases had been followed up for 3-24 months.There were no severe complications in all cases.45 patients with single I brachytherapy mean blood serum PSA were（16.50±12.43） ng/mL before treatment and（0.67±0.28） ng/mL three months later after treatment with significant difference（P 0.05）.The PSA of four patients did not reduce after 3 months of treatment.One patient occured bone metastasis after 18 months,2 cases had biochemical progression in 19.3 months post-operation,2 cases died in 36 months post-operation.Cumulative PSA progression free survival rate was 89.8%.In control group one case died in 21 months post-operation.1 case was diagnosed with bone metastasis 14 months after the surgery.1 case had biochemical progression an average of 16 months post-operation.Cumulative PSA progression free survival rate was 85%.Conclusion Biopsy and brachytherapy with I seeds implantation guided by transrectal ultrasounds is an effective,minimally invasive and minimally invasive treatment for prostate canncer.