成人前列腺肉瘤的手术方式探讨及疗效分析

Retrospective analysis of surgical treatment for adult prostate sarcoma

目的 探讨成人前列腺肉瘤的外科手术方式及治疗效果.方法 回顾性分析1985年1月至2013年8月收治的14例前列腺肉瘤患者的临床资料,年龄22-82岁,平均44岁.所有患者均因为排尿困难就诊,1例伴尿潴留,4例伴排便困难.12例行血清PSA检查,PSA值0.003 -11.300μg/L,平均1.300 μg/L,其中3例＞4 μg/L.所有患者均接受B超和CT扫描检查,9例行MRI检查.肿瘤直径5.0-13.5 cm,平均8.3 cm.11例经前列腺穿刺活检诊断为前列腺肉瘤,3例行经尿道前列腺电切术后获得病理诊断.平滑肌肉瘤6例,横纹肌肉瘤2例,恶性纤维组织肉瘤2例,恶性叶状囊肉瘤2例,原始神经外胚层组织肉瘤1例,癌肉瘤1例.14例中,6例行耻骨后根治性前列腺切除术,1例行腹腔镜中转开放式根治性膀胱前列腺切除＋回肠输尿管延长术,3例行经尿道前列腺电切术（姑息）,2例仅手术探查,2例行全盆腔器官切除＋乙状结肠造口粪尿双改道术.结果 14例术后随访5 -37个月,11例于确诊或治疗后存活5-35个月,平均11个月,死亡患者均为盆腔肿瘤进展或复发所致,远处脏器转移以肺、肝和骨最常见,其中7例终末期实行肾造瘘,3例同时行结肠造瘘;2例行全盆腔器官切除＋乙状结肠造口粪尿双改道术者存活,分别随访21个月和37个月,无肿瘤复发;1例术后8个月后失访.结论 前列腺肉瘤罕见,好发于青壮年,预后较差,早期发现、彻底手术仍然是目前最有效的治疗手段。

Objective To evaluate the efficacy of surgical treatment for adult prostate sarcoma.Methods 14 cases of adult primary prostate sarcoma with mean age of 44 years old , ranging 22-82 years,were admitted in our hospital from January 1985 to August 2013.All of them were suffering from different degrees of dysuria.4 cases suffered with difficult defecation and 1 suffered with urinary retention.The PSA level in 12 patients ranged from 0.003 μg/L to 11.300 μg/L, mean 1.300 μg/L.Among them, the PSA level was more than 41μg/L in 3 patients.All the patients accepted the ultrasound and CT scanning.9 of them underwent MRI test.The tumors diameter ranged from 5.0 cm to 13.5cm, mean 8.3 cm.11 of the 14 patients were preoperatively diagnosed by prostate needle biopsy and the other 3 were confirmed by TURP.Histological subtypes were leiomyosarcma in 6 cases, rhabdomyosarcoma in 2 cases, malignant fibrous histiocytoma in 2 cases, primitive neuroectodermal sarcoma in 1 case, carcinoid sarcoma in 1 case and cystosarcoma phylloides in 2 cases.6 patients underwent retropubic radical prostatectomy, 1 patient underwent laparoscopic radical prostatectomy converted to open cystoprostatectomy.3 patients were treated with TURP palliative, 2 patients were operated exploratorily and 2 patients were carried out pelvic exenteration with single loop sigmoid colostomy for both fecal and urinary diversion.Results The follow-up duration in all patients ranged from 5 to 37 months.11 of the 14 patients were died after initial treatment with 5 to 35 months due to the progression of pelvic tumor and recurrence.1 patient lost follow-up 8 months later.The organs of distal metastasis included lung, liver and bone.The 2 patients, who underwent pelvic exenteration, single loop sigmoid colostomy for both fecal and urinary diversion, still survived with tumor relapse free, followed 37 and 21 months later.Conclusions Primary prostate sarcoma is rare and mainly occurred in young adult with poor prognosis.Early diagnosis and complete surgical resection is the besteffective therapy for those patients.