经尿道等离子前列腺电切术及术中快速病理诊治晚期前列腺癌的临床分析

Efficacy of transurethral plasmakinetic resection of prostate combined with intraoperative pathological diagnosis of advanced prostate cancer

目的探讨经尿道等离子前列腺电切术及快速病理在晚期前列腺癌致膀胱出口梗阻的临床应用。方法12例患者均采用经尿道等离子前列腺电切术,术中快速病理均明确前列腺癌诊断,同时行加双侧睾丸切除术,术后3天开始应用氟他胺0.25 g,每天3次,口服,3个月后复查血TPSA,TPSA〈2 ng/ml时,服药1个月后停药,停用后每个月复查PSA,当PSA〉4 ng/ml时再重新开始治疗。结果所有12例患者术后1个月国际前列腺症状评分（IPSS）下降至（9.0±1.2）分,最大尿流率（Qmax）上升为（17.5±2.3）ml/s,膀胱残余尿量为（40±25）ml。术后3个月9例TPSA〈2 ng/ml,另外3例降到术前的10%左右。TPSA、IPSS、Qmax及膀胱残余尿量均较术前有明显改善（P〈0.05）,随访1~5年8例患者仍健在。结论经尿道等离子前列腺电切术中快速病理可明确诊断,为手术去势提供诊断依据,联合最大限度雄激素阻断内分泌疗法可有效解除晚期前列腺癌致膀胱出口梗阻,提高了患者的生活质量。

[Objective]To investigate the clinical application of transurethral plasmakinetic resection of prostate and intraoperative pathological diagnosis to advanced prostate cancer with bladder outlet obstruction（BOO）.[Methods]Twelve cases of advanced prostate cancer were treated with transurethral plasmakinetic resection, and after identification of prostate cancer by intraoperative pathological diagnosis, they were treated by bilateral orchiectomy at the same time. Then oral flutamide 250 mg three times a day was given to the patients from the third day after surgery. Serum PSA was rechecked after 3 months. When PSA〈2 ng/ml, the patients continued to take flutamide for one more month. After the therapy was discontinued the serum PSA was rechecked every month. When PSA〉4 ng/ml, the treatment was resumed.[Results]One month after operation, the International Prostate Symptom Score（IPSS） decreased to（9.0 ± 1.2）, the maximum urine flow rate（Qmax） increased to（17.5 ± 2.3） ml/s, the residue urine volume（RV） was（40 ± 25） ml. Three months after operation, PSA levels of 9 cases were〈2 ng/ml,those of the remaining 3 cases decreased to 10% of the preoperative values. TPSA, IPSS, Qmax and RV were significantly improved（P〈0.05）. All the patients were followed up for 1 ~5 years, 8 of them were still alive.[Conclusions]Intraoperative pathological diagnosis in transurethral plasmakinetic resection of prostate can identify prostate cancer, and help to choose surgery castration. Transurethral plasmakinetic resection of prostate combined with maximal androgen blockade is a safe and effective treatment for advanced prostate cancer in patients with BOO, and can improve life quality of the patients.