摘要
目的探讨^(125)I粒子近距离放射治疗低危前列腺癌术后不良反应及合并症的发生、发展及预后。方法回顾性分析了2007年1月至2015年6月收治的30例前列腺癌病人的临床资料。年龄65~85岁,平均年龄(78.1±5.30)岁。前列腺表面特异性抗原(prostate specific antigen,PSA)4.15~9.8 ng/mL,平均(8.25±1.04)ng/mL,临床TNM分期T_(1c)~T_(2a)N_0M_0,Gleason评分5~7分。前列腺体积38~55 mL,平均(49.1±3.92)mL。在连续硬膜外麻醉下,经直肠超声扫描前列腺,图像传送至计算机计划系统,根据计划行经会阴^(125)I粒子植入术。结果 30例病人植入粒子45~70粒,平均(52.6±6.77)粒。全部病人获得随访,随访时间为12~86个月,平均(40.4±7.01)个月。术后1个月尿路Ⅰ、Ⅱ、Ⅲ、Ⅳ级不良反应发生率分别为66.67%、20%、6.67%、0;术后12个月尿路Ⅰ、Ⅱ级不良反应发生率分别为10%、3.33%,无Ⅲ、Ⅳ级不良反应,缓解率为85.71%。结论^(125)I粒子植入术治疗低危前列腺癌术后急性尿路不良反应较普遍,但程度多较轻且有自限性,经保守治疗大部分于1年内缓解,极少数可能进展为远期严重合并症。术中精确的定位、制定计划及粒子植入操作技术是预防严重合并症的关键。
Objective To analyze the side effects and complication of low-risk prostate cancer after ^125I seeds prostate implant.Methods A total of 30 prostate cancer patients with age ranging from 65 to 85 years [average age of （78.1±5.30） years] were recruited.All patients were treated between January 2007 and June 2015.The prostate specific antigen （PSA） level of these patients was 4.15-9.8 ng/mL [average （8.25±1.04） ng/mL],and the Gleasons Score was 5-7.All patients were clinically staged as T1c-T2aN0M0;30 cases with prostate volume of 38-55 mL,an average of （49.1±3.92） mL.Under continual epidural anesthesia,these patients underwent trans-rectal ultrasound.Pictures were transmitted to the computer system to make plan.According to the plan,patient received 125I seed brachytherapy under the guidance of the trans-rectal ultrasound.Results All 30 cases were implanted seeds of 45-70 （average seeds of 52.6±6.77）.The follow-up period was 12-86 months,with average of （40.4±7.01） months.The urinary side effects of gradeⅠ,Ⅱ,Ⅲ,and Ⅳ were 66.67% and 20% and 6.67% and 0 one month after seeds implant.By conservative treatment,the urinary side effects of gradeⅠand Ⅱwere 10% and 3.33% 12 months after seeds implant.No grade Ⅲ and Ⅳ side effects were found.Symptom remission rate was 85.71%.Conclusion Urinary side effects are common after prostate brachytherapy but are mostly self-limiting in the majority of patients,such side effects resolve within a year after the procedure.Serious complications of grade Ⅳ are rare.Intraoperative accurate localization and making plan and implantation are the key to the prevention of serious complications.
作者
张继伟
阎乙夫
夏溟
Zhang Jiwei Yan Yifu Xia Ming
出处
《首都医科大学学报》
CAS
北大核心
2017年第2期325-328,共4页
Journal of Capital Medical University
