TURP与内分泌治疗前列腺癌下尿路梗阻的比较

The comparison of TURP and hormone therapy for lower urinary tract obstruction caused by prostate cancer

目的比较间歇性内分泌治疗(IHT)和经尿道前列腺电切术(TURP)治疗中晚期前列腺癌(Pca)患者下尿路梗阻的疗效。方法记录两组中经尿动力学证实有流出道梗阻(UOO)和以下尿路症状(LUTS)入院患者治疗前和治疗后3、6、9、12、15、18及24个月的最大尿流率(Qmax)、国际前列腺症状评分(IPSS),残余尿量(R)变化情况;比较两组中以急性尿潴留(AUR)入院患者的拔管成功率;并比较两组在随访24个月期间的不良事件的发生率。结果两种治疗方法都可以改善UOO和LUTS患者的下尿路症状,症状改善出现的时间TURP组要早于内分泌治疗组(3个月vs 6个月),但内分泌治疗组症状缓解期持续时间比TURP组更长(UOO患者15个月vs 9个月,LUTS患者15个月vs 6个月);对AUR患者的治疗,TURP组的拔管实验(TWOC)失败率低于内分泌治疗组(12.5%vs 35.7%,P<0.001);随访期间不良事件发生率TURP组高于内分泌治疗组(23.3%vs 12.7%,P<0.05)。结论 TURP对缓解有流出道梗阻的Pca患者的症状效果满意,仅表现LUTS的患者宜采用IHT。

【Objective】To compare the clinical efficacy of intermittent hormonal therapy（IHT） and transurethral resection of the prostate（TURP） in the treatment of lower urinary tract obstruction due to advanced prostate cancer.【Methods】We collected the data of 115 advanced prostate cancer patients complicated with lower urinary tract obstruction who were treated by TURP or IHT.The maximum flow rate（Qmax）,international Prostate Symptom Score（IPSS） and residual urine volume（R） were selected as the indicators reflecting the degree of lower urinary tract obstruction and were observed before treatment,3,6,9,12,15,18 and 24 months after treatment in patients with Urodynamic outflow obstruction（UOO） and lower urinary tract symptoms（LUTS） in both groups.We also observed incidence of the failed trial without catheter（TWOC） of patients with Acute Urinary Retention（AUR） and the poor outcome in these two groups.【Results】Both treatments can improve the lower urinary tract symptoms in patients with UOO and LUTS,the timing of reach significant improvement in patients treated with TURP is earlier than treated with IHT（3th month﹠6th month）,but the IHT group have longer lasting effect than TURP group（UOO： 15 months ﹠9 months;LUTS：15 months﹠6 months）;a significantly larger number of patients with AUR failed the trial without catheter（TWOC） after IHT when compared to the TURP cohort（12.5% and 35.7%,respectively,P 0.001）;14/60（23.3%） patients in the TURP group were defined as having a poor outcome over the study period,in contrast,was found in only 7/55（12.7%） patients in the IHT cohort.【Conclusion】Patients with prostate cancer and outflow obstruction may derive a good palliative benefit from TURP.IHT is adapted for the men only with LUTS.