摘要
目的探讨局部晚期前列腺癌在6个月新辅助内分泌治疗后,行腹腔镜下前列腺癌根治术的临床价值。方法 30例患者术前均行经直肠超声引导下前列腺12点系统穿刺确诊。根据术前前列腺特异性抗原(PSA)、Gleason评分和MRI检查,所有患者临床诊断为局部晚期前列腺癌,均先行6个月新辅助内分泌治疗(全雄激素阻断),再行腹腔镜下前列腺癌根治术。结果30例患者新辅助内分泌治疗前PSA 15.6~72.3ng/ml,平均25.8ng/ml;新辅助内分泌治疗后PSA降低至0.1~2.8ng/ml,平均0.9ng/ml。手术时间112~256 min,平均160 min;术中出血90~800ml,2例术中输悬浮红细胞600ml。无直肠和周围脏器损伤等严重手术并发症发生,5例局部淋巴结阳性。术后3个月复查PSA 0.001~0.006ng/ml。随访12~30个月,1例在术后18个月出现生化复发,无局部复发及远处转移。结论局部晚期前列腺癌新辅助内分泌治疗能够缩小前列腺体积、降低肿瘤分期,使局部晚期前列腺癌获得手术机会,降低手术难度和并发症;新辅助内分泌治疗后行前列腺癌根治术,是一种有效、安全可行的综合治疗方法,其远期疗效还有待大宗的临床研究和长期随访观察。
Objective To evaluate the clinical efficacy of laparoscopic radical prostatectomy（LRP）for local advanced prostate cancer after a six-month neoadjuvant endocrine therapy. Methods With age ranging from 52 to 83,all patients were screened by transrectal ultrasonography guided12 cores prostate biopsy,all cases were diagnosed as prostate cancer.According to the prostate specific antigen（PSA）in blood before operation,Gleason scores and magnetic resonance imaging,30 cases were diagnosed as local advanced prostate cancer.All cases received six-month neoadjuvant endocrine therap（maximal androgen blockade）and LRP in sequence. Results After six-month neoadjuvant endocrine therapy the PSA reduced from 15.6-72.3 ng/ml（mean：25.8 ng/ml）to 0.1-2.8 ng/ml（mean：0.9 ng/ml）.The operation time was 112-256 minutes（mean：160 minutes）.The intraoperative blood loss was 90-800 ml,and 2 patients receivedred blood cells infusion of 600 ml.No severe complications occurred,such as rectal injuris,peripheral organs injuries and so on.Postoperative pathology found 2 positive surgical margins and 5 positive regional lymph nodes.Three month after LRP,PSA were 0.001-0.006 ng/ml.After a follow-up duration of 12 to 30 months,1 case was found biochemical recurrence without distant metastasis. Conclusions Neoadjuvant endocrine therapy can reduce the volume and clinical stage of prostate cancer significantly,so local advanced patients can undergo operation without increasing operative difficulty and complications.Neoadjuvant endocrine therapy in combination with LRP is an effective and safe treatment for locally advanced prostate cancer.However,further more clinical researches and long-term follow-up are needed to confirm long-term prognosis of patients with prostate cancer.
作者
高强
张保
史玉强
徐震
GAO Qiang;ZHANG Bao;SHI Yu-qiang;XU Zhen(Department of Urology,Aerospace Center Hospital,Beijing 100049,China)
出处
《现代泌尿生殖肿瘤杂志》
2018年第3期145-148,共4页
Journal of Contemporary Urologic and Reproductive Oncology
