药物去势治疗前列腺癌合并尿潴留的临床疗效研究

A study on the clinical efficacy of medical castration in treatment of prostate cancer complicated with urinary retention

目的探讨药物去势治疗前列腺癌合并尿潴留的临床疗效。方法回顾性分析广西壮族自治区江滨医院2017年6月至2020年6月32例前列腺癌合并尿潴留患者的临床资料。患者年龄65~95岁,中位年龄为79.6岁;临床分期为Ⅱ期2例,Ⅲ期11例,Ⅳ期19例。患者均不耐受或不愿意接受根治性手术治疗,不同意行经尿道前列腺电切或膀胱造瘘尿流改道治疗尿潴留。经与患者及其家属沟通,同意选择药物去势治疗,采用最大限度雄激素阻断联合α受体阻滞剂治疗。观察患者治疗后国际前列腺症状评分(IPSS)、生活质量(QOL)评分、最大尿流率(Qmax)、前列腺体积(PV)的变化情况。结果治疗16周后,32例中有26例(81.25%)能够顺利拔除尿管,2例因重症肺炎病情恶化死亡,2例因病情恶化未能进一步随访。能顺利拔除尿管的26例患者治疗后的IPSS、QOL评分均较治疗前降低,差异有统计学意义(P<0.05);在拔尿管4周后的Qmax显著高于刚拔尿管时[(11.1±2.8)ml/s vs(1.2±0.3)ml/s;t=22.737,P=0.000]。28例存活患者治疗12周后的PV较治疗前显著减小[(43.5±10.2)cm^(3) vs(76.0±15.8)cm^(3);t=6.712,P=0.000]。结论药物去势治疗可改善高危、高龄前列腺癌合并尿潴留患者的自主排尿情况。

Objective To investigate the clinical efficacy of medical castration in treatment of prostate cancer complicated with urinary retention.Methods The clinical data of 32 prostate cancer patients complicated with urinary retention in Jiangbin Hospital of Guangxi Zhuang Autonomous Region from June 2017 to June 2020 were retrospectively analyzed.The patients were 65 to 95 years old,with a median age of 79.6 years.The clinical stages were stageⅡin 2 cases,stageⅢin 11 cases and stageⅣin 19 cases.All the patients were intolerant or unwilling to accept radical surgery,and did not agree to the treatment of urinary retention by transurethral resection of the prostate or cystostomy for urinary diversion.After the doctors communicated with the patients and their family members,the patients and their family members agreed to choose medical castration treatment and used the combination of maximum androgen blockade andα-blocker therapy.The changes of International Prostatic Symptomatic Score(IPSS),quality of life(QOL)score,maximum urinary flow rate(Qmax)and prostate volume(PV)were observed after treatment.Results After 16 weeks of treatment,the urinary catheters were successfully removed in 26 of the 32 cases(81.25%),and 2 cases died due to the deterioration of severe pneumonia,and 2 cases failed to be further followed up due to the deterioration of their conditions.The IPSS and QOL scores of the 26 patients whose urinary catheters were successfully removed after treatment were lower than those before treatment,and the differences were statistically significant(P<0.05).The Qmax at 4 weeks after catheter removal was significantly higher than that immediately after catheter removal[(11.1±2.8)ml/s vs(1.2±0.3)ml/s;t=22.737,P=0.000].The PV of the 28 surviving patients was significantly reduced 12 weeks after treatment compared with that before treatment[(43.5±10.2)cm^(3) vs(76.0±15.8)cm^(3);t=6.712,P=0.000].Conclusion Medical castration therapy can improve voluntary urination in high-risk and elderly prostate cancer patients complicated with urinary retention.