现代泌尿外科杂志
現代泌尿外科雜誌
현대비뇨외과잡지
Journal of Modern Urology
2015年
11期
784-786,807
,共4页
刘定益%楚晨龙%周燕峰%王健%夏维木%王名伟%赵晨晖%张翀宇%邵远%唐崎%俞家顺%李文敏%周文龙
劉定益%楚晨龍%週燕峰%王健%夏維木%王名偉%趙晨暉%張翀宇%邵遠%唐崎%俞傢順%李文敏%週文龍
류정익%초신룡%주연봉%왕건%하유목%왕명위%조신휘%장충우%소원%당기%유가순%리문민%주문룡
前列腺肿瘤%根治性前列腺切除%个性化治疗
前列腺腫瘤%根治性前列腺切除%箇性化治療
전렬선종류%근치성전렬선절제%개성화치료
prostatic cancer%radical prostatectomy%individualized treatment
目的：探讨耻骨后根治性前列腺切除（RRP ）或结合内分泌、局部外放疗治疗94例高危前列腺癌的疗效。方法符合D'Amico和中国泌尿外科诊断治疗指南的高危前列腺癌定义者94例，其中70例 T3a ～ T3b患者术前用3个月新辅助内分泌治疗，RRP同时行Denonvillier筋膜前脂肪垫、前列腺、双侧神经血管束整块切除，对其中淋巴管造影提示可疑淋巴结转移49例给予扩大淋巴清扫，其余45例行标准淋巴结清扫。术后对≥pT3a 、Gleason评分≥8、淋巴结转移和切缘阳性者给予6 M 辅助内分泌治疗或加局部外放疗。术后平均随访（66．22±40．00）月，统计手术时间、术中出血量、相关并发症、生化复发例数、生化复发时间和5年生存情况。结果70例高危前列腺癌诊断时PSA平均为（46．45±36．45）ng／mL ，新辅助内分泌治疗3个月后PSA平均为（1．02±1．15）ng／mL（P＜0．01），平均手术时间（178．30±29．67）min ，平均术中出血量（539．90±351．46） mL ，术后证实术前19例cT3a降为PT2c ，吻合口漏2例，继续保留导尿3～4周愈合，淋巴漏2例，经持续引流3～4周痊愈，尿失禁6例，吻合口狭窄1例，生化复发35例，5年总生存率和肿瘤特异性生存率分别为94．2％和96．2％。结论 RRP或结合术后辅助内分泌治疗或加局部外放疗的个体化处理高危前列腺癌是一种安全可行、疗效满意的方法，有望使更多高危前列腺癌从中受益。
目的：探討恥骨後根治性前列腺切除（RRP ）或結閤內分泌、跼部外放療治療94例高危前列腺癌的療效。方法符閤D'Amico和中國泌尿外科診斷治療指南的高危前列腺癌定義者94例，其中70例 T3a ～ T3b患者術前用3箇月新輔助內分泌治療，RRP同時行Denonvillier觔膜前脂肪墊、前列腺、雙側神經血管束整塊切除，對其中淋巴管造影提示可疑淋巴結轉移49例給予擴大淋巴清掃，其餘45例行標準淋巴結清掃。術後對≥pT3a 、Gleason評分≥8、淋巴結轉移和切緣暘性者給予6 M 輔助內分泌治療或加跼部外放療。術後平均隨訪（66．22±40．00）月，統計手術時間、術中齣血量、相關併髮癥、生化複髮例數、生化複髮時間和5年生存情況。結果70例高危前列腺癌診斷時PSA平均為（46．45±36．45）ng／mL ，新輔助內分泌治療3箇月後PSA平均為（1．02±1．15）ng／mL（P＜0．01），平均手術時間（178．30±29．67）min ，平均術中齣血量（539．90±351．46） mL ，術後證實術前19例cT3a降為PT2c ，吻閤口漏2例，繼續保留導尿3～4週愈閤，淋巴漏2例，經持續引流3～4週痊愈，尿失禁6例，吻閤口狹窄1例，生化複髮35例，5年總生存率和腫瘤特異性生存率分彆為94．2％和96．2％。結論 RRP或結閤術後輔助內分泌治療或加跼部外放療的箇體化處理高危前列腺癌是一種安全可行、療效滿意的方法，有望使更多高危前列腺癌從中受益。
목적：탐토치골후근치성전렬선절제（RRP ）혹결합내분비、국부외방료치료94례고위전렬선암적료효。방법부합D'Amico화중국비뇨외과진단치료지남적고위전렬선암정의자94례，기중70례 T3a ～ T3b환자술전용3개월신보조내분비치료，RRP동시행Denonvillier근막전지방점、전렬선、쌍측신경혈관속정괴절제，대기중림파관조영제시가의림파결전이49례급여확대림파청소，기여45례행표준림파결청소。술후대≥pT3a 、Gleason평분≥8、림파결전이화절연양성자급여6 M 보조내분비치료혹가국부외방료。술후평균수방（66．22±40．00）월，통계수술시간、술중출혈량、상관병발증、생화복발례수、생화복발시간화5년생존정황。결과70례고위전렬선암진단시PSA평균위（46．45±36．45）ng／mL ，신보조내분비치료3개월후PSA평균위（1．02±1．15）ng／mL（P＜0．01），평균수술시간（178．30±29．67）min ，평균술중출혈량（539．90±351．46） mL ，술후증실술전19례cT3a강위PT2c ，문합구루2례，계속보류도뇨3～4주유합，림파루2례，경지속인류3～4주전유，뇨실금6례，문합구협착1례，생화복발35례，5년총생존솔화종류특이성생존솔분별위94．2％화96．2％。결론 RRP혹결합술후보조내분비치료혹가국부외방료적개체화처리고위전렬선암시일충안전가행、료효만의적방법，유망사경다고위전렬선암종중수익。
ABSTRACT:Objective To explore the therapeutic effect of retropubic radical prostatectomy (RRP) combined with indi‐vidualized treatment of endocrine and local external beam radiotherapy for 94 cases of high risk prostate cancer .Methods A total of 94 cases were diagnosed as high‐risk prostate cancer according to the D'Amico and CUA Guidelines .Of them 70 cases of T3a -T3b stage received 3‐month neoadjuvant thormonal therapy .In the procedure of RRP ,anterior Denonvillier fascia fat , bulky prostate ,and bilateral NBV were removed .The extended lymph nodes dissection was performed when lymph nodes me‐tastasis was suspected in 49 cases .Other 45 patients had RRP and local lymphadenectomy according to Walsh Method .The as‐sisted 6‐month thormonal therapy or local external beam radiotherapy were given to patients of stage≥pT3a ,Gleason≥8 ,with lymph nodes metastasis and positive surgical margin .The mean follow‐up was (66 .22 ± 40 .00)months .The operation time ,in‐traoperative blood loss ,peri‐operative complications ,numbers and time of biochemical recurrence and 5‐years survival rate were analyzed .Results In the 70 cases of high‐risk prostate cancer ,the PSA level was (46 .45 ± 36 .45)ng/mL and reduced to (1 .02 ± 1.15)ng/mL after 3‐month of neoadjuvant thormonal therapy (P<0 .01) .The mean operation time was (178 .30 ± 29 .67)min ,and the mean blood loss was (539 .90 ± 351 .46)mL .The 19 cases diagnosed to be cT3a before operation improved to be PT2c after operation .The complications included anastomotic leakage in 2 cases ,lymphatic fistula in 2 cases ,incontinence in 6 cases ,of anastomotic stricture in 1 case .Biochemical recurrence occurred in 35 cases .The 5‐year overall survival rate and tumor‐specific survival rate was 94 .2% and 96 .2% ,respectively .Conclusion The high‐risk prostate cancer patients could benefit more from retropubic radical prostatectomy assisted by thormonal therapy or external beam radiotherapy .
