| 以尿潴留为首发表现的前列腺癌临床分析（附43例） |
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| 引用本文： | 黄智峰,钟 喨,赖海标,刘毅豪,吴 松,郑东翔.以尿潴留为首发表现的前列腺癌临床分析（附43例）[J].现代肿瘤医学,2019,0(7):1184-1188. |
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| 作者姓名： | 黄智峰 钟 喨 赖海标 刘毅豪 吴 松 郑东翔 |
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| 作者单位： | 广州中医药大学附属中山医院（中山市中医院）泌尿外科，广东 中山 528400 |
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| 摘 要： | 目的:回顾分析以尿潴留为首发表现的前列腺癌患者的临床特点。方法:收集我院2001年7月至2014年7月以尿潴留为首发症状的前列腺癌患者43例，均经前列腺穿刺活检确诊。3例患者接受腹腔镜下腹膜外前列腺癌根治术，其余40例患者均接受经尿道前列腺电切术（transurethral resection of prostate，TURP）联合内分泌治疗［（最大限度雄激素阻断（maximal androgen blockade，MAB）］。统计其年龄分布、前列腺特异性抗原（prostate specific antigen，PSA）、直肠指检(digital rectal examination，DRE)阳性率、经直肠前列腺穿刺阳性针数、Gleason评分、骨转移、肿瘤分期、治疗后排尿恢复情况、IPSS评分及1年、3年、5年生存率。结果:43例患者的年龄中位数为69岁；直肠指检阳性率达81.4%（35/43）；PSA＞20 ng/ml者占62.8%（27/43）；经直肠前列腺穿刺（12+X针穿刺法）超过7针以上阳性的占76.7%（33/43）；Gleason评分≥7分占95.3%（41/43）；骨转移患者占76.7%（33/43）；临床分期T3b-T4期占88.4%（38/43）；治疗后6个月全部患者恢复了自主排尿，1年生存率为97.7%，3年生存率为79.1%，5年生存率为55.8%。结论:老年男性发生尿潴留应当考虑有前列腺癌的可能性，该类前列腺癌患者病程往往多为晚期且为高危患者，肿瘤压迫侵犯尿道及膀胱颈是排尿困难的主要原因，经尿道前列腺电切术联合内分泌治疗，可有效解除下尿路梗阻，控制肿瘤进展，提高患者生活质量。
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| 关 键 词： | 前列腺癌 尿潴留 经尿道前列腺电切术 内分泌治疗 |
Clinical analysis of prostate cancer with urinary retention as the first clinical manifestation (43 cases) |
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| Huang Zhifeng,Zhong Liang,Lai Haibiao,Liu Yihao,Wu Song,Zheng Dongxiang.Clinical analysis of prostate cancer with urinary retention as the first clinical manifestation (43 cases)[J].Journal of Modern Oncology,2019,0(7):1184-1188. |
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| Authors: | Huang Zhifeng Zhong Liang Lai Haibiao Liu Yihao Wu Song Zheng Dongxiang |
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| Affiliation: | Department of Urology，the Affiliated Zhongshan Hospital of Guangzhou University of Traditional Chinese Medicine (Hospital of Traditional Chinese Midicine of Zhongshan)，Guangdong Zhongshan 528400，China. |
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| Abstract: | Objective:To analyze the clinical characteristics of prostate cancer with urinary retention as the first clinical manifestation retrospectively.Methods:During the time period from July 2001 to July 2014，a total of 43 patients with urinary retention were newly diagnosed as prostate cancer by histological diagnosis carried through the transrectal ultrasonography guided biopsy and carried on Gleason score assessment.3 cases received extraperitoneal laparoscopic radical prostatectomy，and the other 40 cases had been treated by transurethral resection of prostate (TURP) combined with hormone therapy (maximal androgen blockade，MAB）.Age，prostate specific antigen (PSA)，positive rate of digital rectal examination （DRE），positive needles of transrectal biopsy，Gleason score，bone metastasis，clinical stage，urinary function，IPSS score after treatment，and 1，3，5-year survival rate were analysed.Results:The median age of patients was 69 years old.35 patients (81.4%) presented with digital rectal examination positive.The initial serum PSA levels ＞20 ng/ml was found in 27 patients (62.8%).Positive needles ＞7 in the 12+X-needle transrectal ultrasonography guided biopsy was found in 33 patients (76.7%).41 patients (95.3%) showed Gleason score ≥7.Bone metastasis was found in 33 patients (76.7%).And 38 patients (88.4%) showed clinical stage with T3b-T4.All the patients renewed urinary function after 6 months' treatment.1，3，5-year survival rate were 97.7%，79.1%，55.8% respectively.Conclusion:Elderly men with urinary retention as initial clinical manifestations should take prostate cancer into account.High clinical stage was found in most of these patients.Tumor invasion was the main cause of urinary retention.TURP combined with hormone therapy can improve urination symptoms，delay progression of tumor and improve the quality of life of these patients. |
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| Keywords: | prostate cancer urinary retention transurethral resection of prostate hormone therapy |
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