新辅助内分泌治疗联合腹腔镜根治性前列腺切除术治疗高危前列腺癌体会

Clinical experience of neoadjuvant hormornal therapy combine with laparoscopic radical prostatectomy in the treatment of high-risk prostate cancer

目的 探讨先行新辅助内分泌治疗后行腹腔镜前列腺癌根治术治疗高危前列腺癌的可行性及效果.方法 收集2013年10月至2016年1月本院先行新辅助内分泌治疗后,再行腹腔镜根治性前列腺切除术治疗14例高危前列腺癌患者的临床资料,术前病检诊断明确,完成Gleason评分,MRI增强扫描完成临床分期,行骨扫描及相关辅助检查排除远处转移,术前辅助内分泌治疗3～6个月控制PSA＜4μg/L后行腹腔镜根治性前列腺切除术,术后观察患者排尿情况及PSA控制情况等.结果 大部分患者手术时间为130～290 min,无输血、无直肠穿孔患者,术后平均15 d拔除尿管,术后3个月均能自行控尿,术后3例病检切缘阳性,术后3个月复查PSA＜0.2μg/L.结论 高危前列腺癌患者经内分泌治疗后行腹腔镜根治性前列腺切除术是安全可行,但术前需充分评估风险及并发症情况.

Objectives To discuss the feasibility and effect of neoadjuvant hormornal therapy followed by laparoscopic prostatectomy in the treatment of high-risk prostate cancer.Methods The clinical data of 14 cases of high-risk prostate cancer who underwent laparoscopic prostatectomy from October 2013 to January 2016 were collected.After confirming the preoperative pathological diagnosis,Gleason grading and clinical staging in order to eliminate distant metastasis were completed.The PSA was controlled less than 4 μg/L after neoadjuvant hormornal therapy,and laparoscopic prostatectomy followed shortly.The urination and PSA control conditions were observed postoperatively.Results Operation time was 130 ～290 min without blood transfusion and rectal perforation.Urinary tube was pulled out after mean 15 days of surgery,and all patients experienced good urinary continence after 3 months of surgery.The positive surgical margins occurred in three cases.The PSA level was below 0.2 μg/L after 3 months of surgery.Conclusions Laparoscopic prostatectomy is a feasible approach to patients with high-risk prostate cancer after neoadjuvant hormornal therapy.However,it is necessary to assess the risks and complications preoperatively.