CAJ | 학술논문

目的：探讨高危及局部晚期前列腺癌在3个月内分泌新辅助治疗后，行腹腔镜下前列腺癌根治术的临床经验和短期疗效。方法患者年龄55～81岁，所有患者术前行超声引导下的前列腺12点系统穿刺，发现79例前列腺癌患者。根据患者术前血前列腺特异性抗原（PSA）、Gleason评分和磁共振检查，发现其中36例为局限性前列腺癌（A组），43例为高危和局部晚期前列腺癌（B组）。A组穿刺后4～6周行腹腔镜下前列腺根治术，B组先行3个月左右的新辅助内分泌治疗（全雄激素阻断），再行腹腔镜下前列腺癌根治术。结果 A组患者穿刺前PSA 3.6～15.8 ng/ml，平均9.3 ng/ml。B组患者前列腺穿刺前PSA 12.6～45.2 n g/ml，平均23.6 n g/ml。经3个月新辅助内分泌治疗后PSA下降至0.02～3.6 ng/ml，平均1.2 n g/ml。手术时间A组65～180 min，平均136 min；B组70～210 min，平均152 min。术中出血A组30～400 ml，无术中输血；B组50～600 ml，其中2例患者输血红细胞400 ml。两组患者皆无直肠和周围脏器损伤等严重并发症出现。术后病理标本A组发现前列腺切缘阳性2例，无膀胱颈部、精囊和局部淋巴阳性；B组发现前列腺切缘、膀胱颈部和精囊阳性6例，局部淋巴阳性4例。术后1个月复查PSA，A组0.001～0.03 ng/ml，B组0.01～0.45 ng/ml。术后对于其中病理切缘、膀胱颈部、精囊和局部淋巴结阳性以及术后生化复发，皆给予辅助内分泌治疗。患者随访6～20个月，其中A组3例生化复发，1例局部复发，无骨转移和远处转移；B组12例出现生化复发，4例局部复发，2例出现骨转移和远处转移。结论新辅助内分泌治疗后能够明显缩小前列腺肿瘤体积，通过临床降期使高危及局部晚期患者获得手术机会。与局限性前列腺癌相比，并未明显增加手术难度和并发症。新辅助内分泌治疗配合腹腔镜下前列腺癌根治术，为高危及局部晚期前列腺癌患者提供了新的治疗手段。但该方法仍有较高的肿瘤复发和转移发生，与传统的单纯内分泌治疗相比，是否能够改善前列腺癌患者的长期预后，尚有待长期随访结果的观察。目的：探討高危及跼部晚期前列腺癌在3箇月內分泌新輔助治療後，行腹腔鏡下前列腺癌根治術的臨床經驗和短期療效。方法患者年齡55～81歲，所有患者術前行超聲引導下的前列腺12點繫統穿刺，髮現79例前列腺癌患者。根據患者術前血前列腺特異性抗原（PSA）、Gleason評分和磁共振檢查，髮現其中36例為跼限性前列腺癌（A組），43例為高危和跼部晚期前列腺癌（B組）。A組穿刺後4～6週行腹腔鏡下前列腺根治術，B組先行3箇月左右的新輔助內分泌治療（全雄激素阻斷），再行腹腔鏡下前列腺癌根治術。結果 A組患者穿刺前PSA 3.6～15.8 ng/ml，平均9.3 ng/ml。B組患者前列腺穿刺前PSA 12.6～45.2 n g/ml，平均23.6 n g/ml。經3箇月新輔助內分泌治療後PSA下降至0.02～3.6 ng/ml，平均1.2 n g/ml。手術時間A組65～180 min，平均136 min；B組70～210 min，平均152 min。術中齣血A組30～400 ml，無術中輸血；B組50～600 ml，其中2例患者輸血紅細胞400 ml。兩組患者皆無直腸和週圍髒器損傷等嚴重併髮癥齣現。術後病理標本A組髮現前列腺切緣暘性2例，無膀胱頸部、精囊和跼部淋巴暘性；B組髮現前列腺切緣、膀胱頸部和精囊暘性6例，跼部淋巴暘性4例。術後1箇月複查PSA，A組0.001～0.03 ng/ml，B組0.01～0.45 ng/ml。術後對于其中病理切緣、膀胱頸部、精囊和跼部淋巴結暘性以及術後生化複髮，皆給予輔助內分泌治療。患者隨訪6～20箇月，其中A組3例生化複髮，1例跼部複髮，無骨轉移和遠處轉移；B組12例齣現生化複髮，4例跼部複髮，2例齣現骨轉移和遠處轉移。結論新輔助內分泌治療後能夠明顯縮小前列腺腫瘤體積，通過臨床降期使高危及跼部晚期患者穫得手術機會。與跼限性前列腺癌相比，併未明顯增加手術難度和併髮癥。新輔助內分泌治療配閤腹腔鏡下前列腺癌根治術，為高危及跼部晚期前列腺癌患者提供瞭新的治療手段。但該方法仍有較高的腫瘤複髮和轉移髮生，與傳統的單純內分泌治療相比，是否能夠改善前列腺癌患者的長期預後，尚有待長期隨訪結果的觀察。
목적：탐토고위급국부만기전렬선암재3개월내분비신보조치료후，행복강경하전렬선암근치술적림상경험화단기료효。방법환자년령55～81세，소유환자술전행초성인도하적전렬선12점계통천자，발현79례전렬선암환자。근거환자술전혈전렬선특이성항원（PSA）、Gleason평분화자공진검사，발현기중36례위국한성전렬선암（A조），43례위고위화국부만기전렬선암（B조）。A조천자후4～6주행복강경하전렬선근치술，B조선행3개월좌우적신보조내분비치료（전웅격소조단），재행복강경하전렬선암근치술。결과 A조환자천자전PSA 3.6～15.8 ng/ml，평균9.3 ng/ml。B조환자전렬선천자전PSA 12.6～45.2 n g/ml，평균23.6 n g/ml。경3개월신보조내분비치료후PSA하강지0.02～3.6 ng/ml，평균1.2 n g/ml。수술시간A조65～180 min，평균136 min；B조70～210 min，평균152 min。술중출혈A조30～400 ml，무술중수혈；B조50～600 ml，기중2례환자수혈홍세포400 ml。량조환자개무직장화주위장기손상등엄중병발증출현。술후병리표본A조발현전렬선절연양성2례，무방광경부、정낭화국부림파양성；B조발현전렬선절연、방광경부화정낭양성6례，국부림파양성4례。술후1개월복사PSA，A조0.001～0.03 ng/ml，B조0.01～0.45 ng/ml。술후대우기중병리절연、방광경부、정낭화국부림파결양성이급술후생화복발，개급여보조내분비치료。환자수방6～20개월，기중A조3례생화복발，1례국부복발，무골전이화원처전이；B조12례출현생화복발，4례국부복발，2례출현골전이화원처전이。결론신보조내분비치료후능구명현축소전렬선종류체적，통과림상강기사고위급국부만기환자획득수술궤회。여국한성전렬선암상비，병미명현증가수술난도화병발증。신보조내분비치료배합복강경하전렬선암근치술，위고위급국부만기전렬선암환자제공료신적치료수단。단해방법잉유교고적종류복발화전이발생，여전통적단순내분비치료상비，시부능구개선전렬선암환자적장기예후，상유대장기수방결과적관찰。
Objective To investigate the clinical experiences and short-term therapeutic effects of laparoscopic radical prostatectomy (LRP) for high-risk and local advanced prostate cancer after a three-month neo-adjuvant endocrine therapy. Methods With age ranging from 55 to 81, all patients were screened by ultrasound guided 12 cores prostate biopsy, among which 79 cases were diagnosed as prostate cancer. According to the prostate specific antigen (PSA) in blood before operation, Gleason scores and magnetic resonance imaging (MRI), 36 cases were diagnosed as localized prostate cancer (group A), and 43 cases were diagnosed as high-risk and local advanced prostate cancer (group B). Group A was subjected to LRP four to six weeks after biopsy, while group B received three-month neo-adjuvant endocrine therapy (maximal androgen blockade) and LRP in sequence. Results The PSA of group A was 3.6-15.8 ng/ml (mean: 9.3 ng/ml). After three-month neo-adjuvant endocrine therapy, PSA of group B reduced from 12.6-45.2 ng/ml (mean:23.6 ng/ml) before biopsy to 0.02-3.6 ng/ml (mean:1.2 ng/ml). The operation time of group A was 65-180 minutes (mean:136 minutes), and that of group B was 70 to 120 minutes (mean:152 minutes). The intraoperative blood loss of group A was 30-400 ml without blood infusion, while that of group B was 50-600 ml, with 2 patients received red blood cells infusion of 400 ml. No severe complications occurred in both groups, such as rectal injuries, peripheral organs injuries and so on. Postoperative pathology found 2 positive surgical margins in group A, without positive case in bladder neck, seminal vesicle and regional lymph nodes. Group B was found 6 positive cases in prostate resection margin, bladder neck and seminal vesicle, and 4 positive regional lymph nodes. One month after LRP, PSA of group A and group B were 0.001-0.03 ng/ml and 0.01-0.45 ng/ml, respectively. Patients with positive pathologic results in prostate resection margin, bladder neck, seminal vesicle and regional lymph nodes received adjuvant endocrine therapy immediately, as well as those with biochemical recurrence in the follow-ups. After a follow-up duration of 6 to 20 months, 3 cases were found with biochemical recurrence, one case with regional recurrence in group A, without bone metastasis and distant metastasis. In group B, 12 cases were found with biochemical recurrence, 4 cases with regional recurrence and 2 cases with bone metastasis and distant metastasis. Conclusion Neo-adjuvant endocrine therapy can reduce the volume of prostate cancer significantly, allow high-risk and local advanced patients to operation by reducing clinical stage, without increasing operative difficulty and complications obviously, compared to localized prostate cancer. Neo-adjuvant endocrine therapy in combination with LRP provides a new therapeutic approach for patients with high risk and local advanced prostate cancer. However, relative high rates of cancer recurrence and metastasis still exist. Compared with traditional hormone therapy, whether this approach can improve long-term prognosis of patients with prostate cancer still awaits investigation into the results of long-term follow-ups.