晚期前列腺癌合并膀胱出口梗阻的治疗

目的探讨合并膀胱出口梗阻的晚期前列腺癌的治疗方法。方法采用双侧睾丸切除术、经尿道前列腺等离子切除术（TURP）以及间歇雄激素阻断等综合方法治疗合并膀胱出口梗阻的晚期前列腺癌患者73例。结果所有手术均成功,住院时间7.0±2.4d,术前及术后3个月复查尿动力学指标,患者最大尿流率由（8.7±3.2）ml/s升为（19.5±2.6）ml/s（P〈0.05）,国际前列腺症状评分（IPSS）由术前的27.3±5.1降为8.6±1.5（P〈0.05）,血清PSA由治疗前（50.3±27.2）ng/ml降至（10.6±8.2）ng/ml（P〈0.01）,生活质量评分（QOL）由治疗前4.3±1.4降至2.2±0.7（P〈0.05）。随访6～24个月,其中8例分别于术后6～14个月死于前列腺癌,6例术后10个月死于其他疾病,其余患者带癌存活。结论合并膀胱出口梗阻的前列腺癌采用TURP、去势术和间歇雄激素阻断的综合治疗具有创伤小、恢复快等优点,且能延长患者生存期及提高患者的生存质量。

Treatment of Prostatic Carcinoma Complicated with Bladder Outlet Obstruction

Objective To investigate the treatment of prostatic carcinoma complicated with bladder outlet obstruction. Methods 73 cases of prostatic carcinoma complicated with bladder outlet obstruction were treated with bilateral orchidectomy combined with transurethral resection of prostate （TURP） and intermittent male hormone blockage. Results All the operations succeeded. There was no case of infection. The mean days in hospital were 7.0± 2.4. IPSS decreased from 27.3 ± 5.1 preoperatively to 8.6 ± 1.5 postoperatively （ P 〈 0. 05） , QOL decreased from 4.3 ± 1.4 to 2.2 ± 0.7 （ P 〈 0.05 ）, Qmax increased from （ 8.7 ± 3.2） ml/s to （19.5±2.6） ml/s （P 〈 0. 05） ,PSA decreased from （50.3 ±27.2） ng/ml to （10.6 ±8.2） ng/ml^-1（P 〈 0. 01 ）. The follow up was 6 - 24 months. 8 cases died of prostatic carcinoma and 6 cases died of other diseases. The others survived with carcinoma. Conclusion Combined therapy, which includes bilateral orchidectomy,TURP and intermittent male hormone blockage,for prostatic carcinoma complicated with bladder outlet obstruction has advantages of minimal trauma and rapid recovery. It can prolong life span, improve the quality of life, and be worth of wide application.