氩氦刀冷冻术联合间歇性内分泌治疗治疗局部晚期前列腺癌的初步研究

A preliminary clinical study of argon-helium cryoablation combining with intermittent hormonal therapy for locally advanced prostate cancer

目的探讨氩氦刀冷冻术(argon-helium cryoablation,AHC)联合间歇性内分泌治疗(intermittent hormonal therapy,IHT)治疗局部晚期前列腺癌(locally advanced prostate cancer,LAPC)的疗效和安全性。方法回顾性分析经直肠超声引导下经会阴前列腺穿刺AHC联合IHT治疗的21例LAPC患者的临床资料,并与18例单纯行IHT治疗的LAPC患者进行对照。评估的指标包括血清总前列腺特异性抗原(total prostate specific antigen,tPSA)、最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、前列腺体积、前列腺MRI和全身骨扫描,生活质量调查采用欧洲癌症研究与治疗组织的QLQ-C30总量表和QLQ-PR25子量表,并记录不良反应。结果 AHC治疗患者的tPSA提前达到最低值,Qmax和IPSS评分改善明显,前列腺体积明显缩小,第一轮停用内分泌药物的时间也明显延长;躯体功能和性功能的明显下降以及局部的疼痛,对患者的生活质量造成一定的影响。AHC术后主要并发症为阴囊水肿、盆腔疼痛、闭孔神经炎、尿道腐肉和后尿道狭窄,但未出现尿失禁、尿道直肠瘘等严重并发症。结论 AHC联合IHT治疗LAPC是一种可选择的安全、有效的方法。

Objective To evaluate the safety and efficacy of transrectal ultrasound guided transperineal argon-helium cryoablation （AHC） combining with intermittent hormonal therapy （IHT） for locally advanced prostate cancer （LAPC）. Methods To retrospectively analyze the data of 21 cases of LAPC treated with AHC and IHT （AHC group）, and to compare with the data of 18 patients treated with IHT only （IHT group）. The indicators for assessment included tPSA, maxi- mum flow rate （Qmax）, IPSS, prostate volume, MRI and SPECT. The health related quality of life was described by European cancer research and treatment organization （ECRTO） QLQ-C30 and QLQ-PR25 module, and the adverse events were recorded exactly. Results The tPSA values of AHC group reached the nadir in advance, Qmax and IPSS were improved more than IHT group, and the prostate volume was significantly reduced in AHC group. The first round of withdrawing endo- crine drugs prolonged longer than IHT group significantly. The quality of life of the patients treated with AHC was affected by decreasing of physical and sexual function, as well as pelvic pain. The main complications of AHC were scrota[ edema, pelvic pain, obturator neuritis, urethral sloughing and posterior urethral stricture. There was no case with severe complication such as urinary incontinence and urethrorectal fistula. Conclusions AHC combined with the IHT was an optional method with security and effectivity in the treatment of LAPC.