TURP术后前列腺偶发癌去势治疗的临床观察

目的：分析经尿道前列腺电切（transurethral resection of prostate,TURP）术后前列腺偶发癌（incidental carcinoma of the prostate gland,ICPG）的治疗方法和随访结果。方法：对2001年1月-2006年12月532例TURP治疗患者的临床资料进行回顾性分析。术后病理检出前列腺腺癌32例,18例行去势治疗,14例观察等待。对比术后病理诊断为前列腺癌的患者与前列腺增生的患者的前列腺抗原。结果：PSA值〈4ug/ml的390例患者中,前列腺腺癌检出率5．38％;PSA值4～10ug／ml的142例患者中,检出率7．75％,二者差异无统计学意义（X^2=1．28,P〉0．05）。29例获随访,随访19～86个月,平均（65．3±32．6）个月,3例失访。治疗组12例无瘤存活,观察组4例无瘤存活。观察等待与去势治疗患者的无瘤生存率之间差异有统计学意义（X^2=5．306,P〈0．05）。结论：PSA值对于前列腺偶发癌的预测作用不可靠,去势治疗可减轻偶发前列腺癌患者临床进展。     

前列腺偶发癌12例报告

目的　探讨前列腺偶发癌的治疗方法及预后。方法　对 12例前列腺偶发癌的临床和病理资料进行回顾性分析。结果　高分化腺癌 9例 ,低分化腺癌 3例。术后行双侧睾丸切除术 10例 ,另外 2例仅行内分泌治疗。其中 9例得到 1～ 7年随访 ,结果 5例无瘤生存 ,2例无瘤死亡 ,2例死于肿瘤复发及转移。结论　前列腺偶发癌的治疗可根据病人的年龄、全身情况、肿瘤的临床分期及病理分级来决定治疗方案。双侧睾丸切除术可作为常规手段。对前列腺偶发癌的随访可采用前列腺特异性抗原动态监测 ,直肠指诊 ,经直肠B超及在其引导下活检。     

经直肠超声引导下穿刺活检在前列腺癌诊断中的临床应用价值

目的 探讨经直肠超声引导下改良6点(6+X)前列腺穿刺活检术在前列腺癌诊断中的临床应用价值.方法 对2013年7月-2015年7月在锦州医科大学附属第一医院就诊的224例临床疑似前列腺癌患者的临床资料进行回顾性分析.所有患者均进行了经直肠超声引导下改良6点前列腺穿刺活检术及手术治疗,将穿刺诊断结果与术后病理结果进行比较.结果 224例疑似前列腺癌患者中,129例经直肠超声引导下改良6点前列腺穿刺术诊断为前列腺癌,90例诊断为前列腺增生,此219例诊断结果与术后病理相符,另5例穿刺活检诊断为前列腺增生而术后病理证实为前列腺癌.穿刺活检诊断前列腺癌的敏感度、特异度、准确度分别为96.3％、100.0％、97.8％,传统的6针法前列腺穿刺术的诊断准确率为93.3％(209/224),两者比较差异有统计学意义(P＜0.05).结论 经直肠超声引导下穿刺活检对于前列腺癌的诊断是一种安全可靠的辅助诊断方法,且改良6点比传统的6针法前列腺穿刺活检术诊断前列腺癌的准确率更高.     

前列腺偶发癌

前列腺偶发癌崔瑞林１李银岚１郭玉生２张韬２关键词前列腺肿瘤前列腺增生偶发癌中国图书资料分类法分类号Ｒ７３７．２５１９８６～１９９６年我们两家医院泌尿外科共收治前列腺增生症４９８例，均行耻骨上经膀胱前列腺摘除术，术后病理发现前列腺偶发癌２７例，报告如下...     

前列腺癌的MR诊断及影响因素

目的 :研究 MR对前列腺癌的定性诊断及分期诊断的能力 ,讨论对诊断准确性有影响的因素。方法 :回顾性分析 2 45例、30 8人次行前列腺 MR检查的影像资料及临床资料 ,着重研究了其中 15 8例病理证实的前列腺癌患者的 MR表现及分期 ,并与临床病理分期对照。结果 :MR能显示 80 .4%的前列腺癌 ,分期的准确率为 81.1%。前列腺活检后 3周内、内分泌治疗后、既往患前列腺炎的患者定性诊断准确率稍低 ,注意观察前列腺尖部、神经血管束及包膜轻度不规则的情况可提高定性和分期诊断的准确性。对中央带病灶 MR诊断效果不好。结论 :MR是评价前列腺癌的一种很好的影像学方法。对病史资料的全面了解、根据情况运用多种 MR检查方法及不断总结提高诊断者的经验会提高 MR对前列腺癌的定性诊断和分期诊断的准确率。     

MRI三维立体重组在前列腺癌诊断和治疗中的作用

目的评价前列腺MRI三维（3D）立体重组在前列腺癌诊断和治疗中的作用。方法28例前列腺癌患者，年龄54～76岁，平均66．3岁。根据穿刺活检结果，14例为外周带癌，3例为中央腺体癌，另外11例患者为前列腺癌治疗后复查患者，其中9例采用内分泌治疗，2例采用放射性粒子置入治疗。所有患者均行直肠内线圈的轴面T2WI序列扫描，所得图像经3D-Doctor软件处理后得到3D重组立体图像。结果14例前列腺外周带癌患者的3D重组立体图像中，有4例显示癌区局限于外周带内，占位效应不明显，外周带形态未见变化；其余10例癌组织向外周带外生长，造成局部外周带增厚，包膜外凸。3例中央腺体癌患者3D图像表现为受累中央腺体体积增大，压迫相邻外周带。2例放射性粒子置入患者可以清楚地显示出放射性粒子在前列腺内的空间分布情况；9例内分泌治疗后患者可见前列腺整体和癌区的体积缩小，包膜外凸减轻。结论3D重组图像可以显示出前列腺外周带、中央腺体和癌区的立体位置关系，为穿刺活检提供了更直观的信息。前列腺MRI三维立体重组在前列腺癌诊断和治疗中可以发挥一定的辅助作用。     

体部伽玛刀治疗复发性前列腺癌31例

目的分析伽玛刀治疗复发性前列腺癌的治疗效果。方法31例复发性前列腺癌患者，伽玛刀治疗以60％～70％等剂量线包绕计划靶区；剂量每次3．8-5．0Gy，治疗次数为10～13次，总放射剂量41．8～55．0Gy．每日或隔日治疗。其中，13例同时及伽玛刀治疗后配合内分泌药物治疗。结果治疗后随访期内前列腺特异性抗原值达到完全缓解19例，前列腺特异性抗原值达到部分缓解10例；结束治疗后3个月影像学检查总的有效率为74．2％（23／31）。3年总的生存率为61．3％。配合内分泌药物治疗和未配合内分泌药物治疗的3年生存率分别是61．5％和61．1％。随访期内未见严重放射性并发症。结论对复发性前列腺癌采用伽玛刀治疗是较有效的局部治疗方法。     

经直肠超声前列腺弱回声灶与病理结果的对照分析

目的:通过经直肠超声检查前列腺弱回声结节声像图表现与病理结果进行对照分析,以期提高经直肠超声对早期前列腺癌的检出率.方法:经直肠超声检查前列腺弱回声结节患者共84例,观察结节的面积、多少、分区与病理组织学的关系,结合术前血清前列腺抗原(P SA值)进行综合分析.结果:84例前列腺弱回声结节经术后病理检查证实,前列腺癌45例(53.57％),前列腺上皮肉瘤17例(20.24％),结节样增生22例(26.19％).其中检出恶性改变62例,总检出率73.81％.结论 经直肠超声诊断前列腺弱回声结节,观察结节的面积、多少、分区以及结合血清前列腺特异性抗原指标的测定结果进行综合分析,有助于提高早期前列腺癌的检出率.     

PI-RADS v2.1联合ADC值对PSA灰区前列腺癌的诊断效能评估

目的 ：探讨前列腺影像报告和数据系统2.1版（PI-RADS v2.1）联合ADC值对前列腺特异性抗原（PSA）灰区前列腺癌的诊断价值。方法：回顾性收集105例PSA值在4～10μg/L前列腺病变患者的临床及影像资料。所有患者均行3.0 T MRI检查,并于8周内经穿刺或手术得到病理结果,根据病理结果分为前列腺癌组（33例）与非前列腺癌组（72例）。分析PI-RADS v2.1联合ADC值对PSA灰区前列腺癌的诊断价值。结果：PI-RADS v2.1联合ADC值诊断PSA灰区前列腺显著癌的AUC为0.900,高于单独使用PI-RADS v2.1的AUC(0.824),差异有统计学意义（P<0.05）。结论：PI-RADS v2.1联合ADC值可提高对PSA灰区前列腺癌的临床诊断效能。     

3.0T MRS对前列腺外周带癌的诊断价值及其与PSA相关性研究

目的 探讨3.0T磁共振波谱(MRS)对前列腺外周带癌的诊断价值及其与前列腺特异性抗原(PSA)的相关性研究.资料与方法 对15名正常自愿者和43例经病理证实的前列腺疾病患者行MRI常规平扫及MRS检查,分析各组间[胆碱(Cho)+肌酸(Cr)]/枸橼酸(Cit)比值及其与PSA之间的相关性.结果 前列腺癌肿组PSA值明显高于增生组,前列腺癌肿组的(Cho+Cr)/Ci比值与PSA值呈正相关性(r=0.424,P=0.049);各组间(Cho+Cr)/Ci比值从大到小依次为前列腺癌肿组、增生组、前列腺癌非癌外周带及正常外周带(P=0.000);当(Cho+Cr)/Ci比值为0.85时对前列腺外周带癌诊断的敏感性、特异性及准确性分别为83%、87%和85%.结论 3.0 T体表线圈MRS对前列腺疾病具有较高诊断价值,联合PSA值及MRS可明显提高对前列腺癌的检出率.     

社区中老年人群前列腺疾病筛查的价值

目的探讨联合应用经直肠超声(TRUS)、前列腺特异性抗原(PSA)和直肠指检(DRE)方法筛查前列腺癌的意义。方法 2010年1月—2012年3月,对来社区卫生中心就诊的325例45～80岁男性,联合应用TRUS、PSA及DRE方法,观察前列腺疾病的分布情况;三者均为阳性作为前列腺癌高风险者行前列腺穿刺活检。结果 325例中,前列腺增生、前列腺结石、前列腺囊肿及前列腺癌分别为256例(78.77%)、33例(10.16%)、31例(9.53%)和5例(1.54%)。前列腺增生和前列腺结石在不同年龄分布差异具有统计学意义(P<0.05);与临床前列腺癌组比较,本组B期以下早期癌占80%,临床组B期以下早期癌只占26.47%,且多为偶发癌;转移癌的诊断率筛查组低于临床组,临床组低分化癌的比率高于筛查组(P均<0.05)。结论社区中老年男性体检中,进行以TRUS、PSA及DRE为主的筛查,是早期发现前列腺癌的最佳途径,对临床早期诊疗具有重要的指导意义。     

前列腺癌和增生的MRI与病理对照研究

目的 研究前列腺癌不同ＭＲＩ表现的病理基础,以提高ＭＲＩ对前列腺癌和增生诊断的准确性。方法 观察经病理证实的４３例前列腺癌和４０例增生患者的前列腺形态及信号改变,并加以比较,前列腺癌组中１７例取前列腺左右两侧外周区上中下、左右移行区上下共１０点进行穿刺,对穿刺组织分别进行病理检查,同时计算癌变组织占总穿刺体积的百分比,并与其ＭＲＩ进行对比。结果 前列腺癌形态规则３１例,不规则１２例,增生组分别为３     

Incidental finding of rectal carcinoma during transrectal US for prostatic diseases.

During transrectal ultrasound (TRUS), rectal carcinoma was an incidental finding in seven patients among a series of 5,000 TRUS examinations. TRUS was performed in seven patients with symptoms characteristic of prostatic diseases. All seven patients underwent examination by at least one physician before TRUS and, except for abnormal prostatic findings, no tumors were detected during digital rectal examination (DRE). The tumors were clearly visualized with TRUS and were easily palpated during DREs performed after TRUS. They were large and were located mainly along the posterior and lateral walls of the rectum. All the tumors were diagnosed by means of proctoscopy; the biopsy findings were positive, and the pathologic staging indicated advanced disease: adenocarcinoma of the rectum with a minimum grade of Dukes C. It is recommended that, in addition to evaluation of scans obtained in the transverse plane, the multiplane transducer be used to evaluate the longitudinal plane of the rectum for detection of possible undiscovered tumors.     

Expression of nuclear Ki-67 antigen in prostatic high grade intraepithelial neoplasia and prostatic carcinoma

BACKGROUND/AIM: Prostatic intraepithelial high grade neoplasia (PINHG) is accepted as preneoplastic lesion in prostatic carcinoma. One of the fundamental events in early oncogenesis is the disruption of proliferative activity. One of the numerous regulatory proteins is Ki-67 expressed in all proliferating cells. Index Ki-67 is considered to have prognostic significance. The aim of the study was to compare the level of proliferation in hyperplastic epithelium, prostatic carcinoma (Gleason score > 6) and PINHG. METHODS: Micromorphological examination was done in 85 patients. Pathohistological analysis was performed on standard histologic specimens with the estimation of Gleason score and the presence of PINHG in its surroundings. Nuclear proliferative activity was analyzed immunohistochemically in 19 cases, using a monoclonal anti-Ki-67 antibody. RESULTS: PINHG was found in prostatic carcinoma surrounding in 30% of the patients. In hyperplastic epithelia Ki-67 proliferative activity was 1,08, in PINHG 2,25 (p < 0,05), while in prostatic cancer, Ki-67 index was 17,64. Proliferative activity in prostatic carcinoma was significantly higher than in PINHG (p < 0,001) and hyperplasia (p < 0,001). CONCLUSION: This study confirmed that high grade PIN lesion predominately appears in the surrounding of poor or moderately differentiated prostate carcinoma, and that it represents progressive disorder of proliferation in preneoplastic and neoplastic prostatic epithelium.     

The ultrasound appearances of prostatic cancer with histological correlation

An analysis of the ultrasound appearances of the prostate with its capsule and periprostatic structures was performed in 221 patients with a histologically confirmed diagnosis of prostatic cancer. The cancers were histologically graded into well, moderate and poorly differentiated adenocarcinoma and transitional cell carcinoma. The results of this study indicate that an ill-defined hypoechoic area is the commonest appearance of prostatic cancer; this was seen in 96% of our 221 patients. The cancers were staged by ultrasound into confined (T0, T1, T2) and unconfined (T3) cancers. A breach of the capsule was seen in 55% of cases. In this unconfined group all cancers were hypoechoic in comparison with 92% in the confined group. In the confined cancer group the areas of abnormal echogenicity were present in more than one prostatic quadrant in 76%. Mostly commonly two prostatic quadrants were affected. The abnormal echogenicity was noted in the posterior quadrants of the prostate more commonly (58%) than in the anterior quadrants. The prostate gland appeared round in 67%, semicircular in 25% and crescentic in 8%. The gland was symmetrical in 68%. The prostatic capsule appeared regular in 86% of patients with a confined cancer. In 70% of cases of extensive but confined cancer there was loss of demarcation between the central and peripheral zones of the gland. The unconfined cancer group all had a breach of the capsule and all glands were heterogeneous due to hypoechoic areas. The breach affected more than one quadrant in 81% and most commonly the capsular breach involved two prostatic quadrants. An anterior breach of the capsule was noted much more frequently than a posterior breach. Forty-four per cent of cases had three or four quadrants of the gland involved. In 3% of cases of proven prostatic cancer no definite ultrasound abnormality could be detected. Calcification was seen within the gland in association with the cancer in 63% with approximately equal frequency in confined and unconfined disease. The seminal vesicles showed definite evidence of infiltration in 10%. Both seminal vesicles were seen in 61% and thought to be normal. In 8% only one was seen. Failure to demonstrate either seminal vesicle occurred in 21%. There was no correlation between the ultrasound appearances of prostatic cancer and the histological grading of the tumour.     

前列腺癌的CT诊断及评价

目的 评价CT在前列腺癌诊断及分期中的价值。材料与方法 回顾性分析经病理证实的30例前列腺癌CT表面及其中6例治疗后的CT表现,28例行平扫和增强,2例行平扫,扫描层厚和间距均为5mm。由两位高龄CT医师分析其CT表现,并进行CT分期。结果 30例前列腺癌中,前列腺边缘隆起乾占83．33％,局限性前列腺密度减低或不均匀者占90％,治疗前CT分明的准确率为80％,Ⅲ期以上的准确率为92％。6例去势治疗后,5例肿瘤明显缩小。结论 前列腺边缘结节状隆起和边缘毛糙,前列腺局限性密度减低是CT诊断前列腺癌的主要征象,CT对肿瘤的临床分期及治疗后疗效的评价具有较大的价值。     

Breast cancers in women 35 years of age and younger: mammographic findings

During an 8-year period, 74 breast cancers were diagnosed in 66 patients 35 years of age and younger who underwent preoperative mammography. Mammograms and clinical data in these women were reviewed retrospectively to evaluate the mammographic findings and the efficacy of mammography. In 58 cases the cancer was detected by means of both clinical examination and mammography; in eight cases, mammography alone enabled readers to find the lesion; in seven cases, the lesion was found by means of clinical examination, but mammograms were negative; and in one case a cancer was found by means of incidental biopsy of the contralateral breast. Although 34 patients (52%) had dense breasts, mammography demonstrated the lesion in 66 cases (89%); the most common mammographic finding was microcalcifications, with or without associated masses (n = 28 [38%]). The authors do not suggest that screening of women younger than 35 years be performed routinely, but they believe that mammography can be valuable in screening young women at high risk for breast cancer or in confirming and suggesting prompt biopsy of a suspicious lesion.     

难治性妇科恶性肿瘤的介入化疗(附58例报告)

目的：探讨难治性妇科肿瘤介入化疗的应用价值。方法：对58例妇科肿瘤（宫颈癌35例,宫颈癌术后复发8例,卵巢癌6例,卵巢癌术后复发7例,子宫内膜癌2例）行介入治疗,并对其疗效,毒副反应进行了观察与评定。结果：介入治疗有效率为89．6％,其中33例行子宫癌根治术,2例癌细胞消失,6例地效,无并发症发生。结论：介入治疗疗效好,不良反应少,是治疗妇科难治性肿瘤的有效方法。     

Renal parenchymal neoplasm as a chance finding during hepatobiliary echography

Renal cell carcinomas are often diagnosed as incidental findings during abdominal US or CT carried out for extra-urological reasons. In order to ascertain the incidence of renal carcinoma two groups of patients were considered: a) 2400 outpatients who had undergone hepato-biliary US for routine screening; b) 1330 inpatients who had undergone US, for non-urological purposes, which had been systematically extended to the kidneys. Two cases of renal cell carcinoma (PT1) were found in group A. Four cases were found in group B--2 of them were stage PT1, and 2 were PT3. These results show how a certain number of unsuspected and early-stage renal cell carcinomas can be diagnosed by US, even when the examination is not intended as a renal study. On the basis of the above observations, we suggest that US be performed in all upper abdomen examinations. At any rate, right kidney US seems to us mandatory when hepatobiliary US is performed.