超卢引导细刀头氩氦刀经皮冷冻治疗乳腺纤维腺瘤的临床研究

目的:探讨细刀头氲氦刀靶向冷冻治疗乳腺纤维腺瘤的临床应用价值.方法:在彩色超声引导下应用Cryo-Hit氩氦刀对23例乳腺纤维腺瘤经皮靶向冷冻治疗.结果:23例冷冻治疗后无感染、休克、血小板减少等并发症发生.术后随访6～24月,彩超检查19例病灶消失,4例病灶缩小约60%,再次治疗后病灶消失;23例乳腺皮肤均无瘢痕存留.结论:彩色超声引导细刀头氩氦刀经皮靶向冷冻治疗乳腺纤维腺瘤是安全、有效、操作简便的一种方法,可以避免常规手术切除遗留瘢痕的缺点.     

高龄危重患者良性前列腺增生氩氦刀冷冻治疗研究(附21例报告)

目的:评价高龄危重患者BPH经皮冷冻的临床疗效。方法:使用ENDCARE冷冻手术系统,对72～91岁,同时伴有明显心肺功能障碍的21例BPH患者实施B超引导下的氩氦刀冷冻治疗,观察术后前列腺活检、前列腺超声图像、尿流率、血清PSA等变化。结果:术后前列腺组织出现变性、坏死,表现为完全消融现象;氩氦刀治疗前后平均尿流率分别为(3.8±2.1)、(17.0±5.8)ml/s(P<0.01);术前血清PSA(3.7±2.4)μg/L,术后1周(22.6±13.1)μg/L,与术前相比明显增高(P<0.01),术后4周(1.7±1.4)μg/L,与术前相比明显降低(P<0.05)。结论:经皮氩氦刀冷冻治疗BPH近期疗效满意,是高龄危重患者较好的治疗方法。     

氩氦刀冷冻消融与射频消融在肝癌治疗中的临床应用

目的探讨氩氦刀冷冻消融与冷循环射频消融(cool-tip radiofrequency ablation,RFA)在恶性肝肿瘤治疗中的临床应用价值。方法超声引导下氩氦刀冷冻消融治疗肝癌38例共42个病灶;经超声引导下RFA治疗肝癌40例共44个病灶,治疗前后经超声造影、增强CT或增强MRI检查明确诊断及评价疗效。结果 42个病灶经一次冷冻消融治疗后32个达完全消融,10例经再次冷冻消融后达到完全消融;44个病灶经一次RFA治疗后完全消融33个,11例经再次RFA后达到完全消融。两者一次完全消融率分别为76.2%(冷冻消融)和75%(RFA),差异无统计学意义。结论氩氦刀冷冻消融和冷循环RFA均能有效地原位灭活肝癌细胞,是有效的非手术治疗恶性肝肿瘤的方法之一。     

超声引导细刀头氩氦刀经皮冷冻治疗乳腺纤维腺瘤的临床研究

目的：探讨细刀头氩氦刀靶向冷冻治疗乳腺纤维腺瘤的临床应用价值。方法：在彩色超声引导下应用Cryo-Hit氩氦刀对23例乳腺纤维腺瘤经皮靶向冷冻治疗。结果：23例冷冻治疗后无感染、休克、血小板减少等并发症发生。术后随访6～24月,彩超检查19例病灶消失,4例病灶缩小约60％,再次治疗后病灶消失;23例乳腺皮肤均无瘢痕存留。结论：彩色超声引导细刀头氩氦刀经皮靶向冷冻治疗乳腺纤维腺瘤是安全、有效、操作简便的一种方法,可以避免常规手术切除遗留瘢痕的缺点。     

CT-Pinpoint定位系统导引下氩氦刀治疗体部肿瘤

目的探讨CT-Pinpoint定位系统导引下氩氦刀治疗体部肿瘤的可行性、安全性及疗效评价。方法 47例经病理证实的体部肿瘤(58处病灶)在CT-Pinpoint定位系统导引下经皮行氩氦刀冷冻消融治疗,术后计算冰球覆盖率。结果36.21%(21/58)、48.28%(28/58)、15.52%(9/58)的病灶冰球覆盖率分别为90.0%、80.1%~90.0%、≤80.0%;所有病灶穿刺准确率为100%,首次进针准确率为96.30%(130/135);并发症发生率14.89%(7/47):其中气胸3例,肺出血2例,尿失禁1例,皮肤冻伤1例。结论 CT-Pinpoint定位系统引导下氩氦刀冷冻消融体部肿瘤安全有效,具有较高临床应用价值。     

氩氦刀冷冻消融术治疗局限性前列腺癌的疗效分析

目的探讨氩氦刀冷冻消融术治疗局限性前列腺癌的疗效及安全性。方法回顾性分析2014年1月至2019年12月本院行直肠超声引导下经会阴前列腺氩氦刀冷冻消融的21例局限性前列腺癌患者的临床资料并进行随访研究。评估患者的血清总前列腺特异性抗原(tPSA)、国际前列腺症状评分(IPSS)、生活质量(QOL)评分、前列腺磁共振成像(MRI)及全身骨扫描, 并记录生化复发及并发症情况。结果术后3个月, 所有患者的血清tPSA、IPSS评分和QOL评分与治疗前比较明显下降, 差异均有统计学意义(均P<0.001);术后6个月的血清tPSA水平低于术后3个月, 差异有统计学意义[(0.012±0.013)ng/mL vs.(0.096±0.174)ng/mL,P<0.05];术后1年复查前列腺体积由术前(44.85±19.66)mL缩小至术后(19.90±11.63)mL, 差异有统计学意义(P<0.05)。随访期间, 无死亡病例, 无局部进展或转移, 2例术后出现远期并发症, 1例出现生化复发。结论氩氦刀冷冻消融术治疗局限前列腺癌疗效确切, 且能缓解尿路症状, 改善生活质量, 是治疗...     

超声引导下经会阴冷冻治疗局限性前列腺癌

目的 总结超声引导下经会阴冷冻治疗局限性前列腺癌的安全性和近期疗效. 方法 伴严重并发症不能接受根治性手术或拒绝开放手术、预期寿命<10年、前列腺体积≤40 ml的局限性前列腺癌患者26例.经直肠B超引导下前列腺穿刺活检,证实为前列腺癌,Gleason评分2～4分6例、5～7分20例.血清PSA平均11.9(4.7～19.2)ng/ml.临床分期T_(1a～b)N_0 M_0 1例、T_(1c)N_0 M_0 10例、T_(2a) N_0 M_0 7例、T(2b) N_0 M_0 4例、T_(2c)N_0 M_0 4例.均行超声引导下经会阴冷冻治疗,采用氩氦靶向双冷冻技术.观察其即刻和迟发并发症发生情况.术后2年内每3个月,以后每6个月复查PSA 1次.PSA截止值≥0.5 ng/ml认为治疗失败.患者术后6个月均建议行前列腺穿刺活检.结果 26例平均手术时间(102±32)min,均未输血.术后平均住院(6±2)d.拔除尿管后,控尿满意22例;4例尿失禁3～7 d后恢复控尿;原有性功能者9例,术后出现勃起功能障碍5例;未发生尿潴留和尿道直肠瘘.26例随访平均22(6～30)个月,PSA<0.5 ng/ml 23例,PSA≥0.5 ng/ml 3例;术后6个月前列腺穿刺活检20例,均为阴性. 结论 超声引导下经会阴冷冻治疗局限性前列腺癌安全有效,远期疗效尚需进一步观察后明确.     

氩氦刀冷冻治疗前列腺癌的手术配合

目的总结在经直肠超声引导下,氩氦刀冷冻治疗前列腺癌的手术配合及护理体会。方法对12例氩氦刀超低温冷冻治疗前列腺癌术的术前访视、用物准备和术中护理配合进行回顾性分析。结果 12例手术均顺利完成。手术时间90-120min,术中顺利,术后均安全返回病房。结论术前做好针对老年患者的访视,充分的手术用物准备,合理安置手术体位,术中配合,熟练掌握温度控制及手术步骤,避免损伤尿道、直肠,是确保氩氦刀冷冻治疗前列腺癌手术成功的关键。     

MR引导下氩氦刀冷冻消融术治疗骨盆肿瘤的临床应用

目的探讨MR引导下氩氦刀冷冻消融治疗术治疗骨盆肿瘤的应用价值。方法9例骨盆肿瘤患者于我院接受MR引导下氩氦刀冷冻消融术。经术前定位,按照病灶距离体表最近和安全性原则选择最佳进针层面与路径,将冷冻针穿入病灶内进行冷冻消融。结果操作过程耗时1.5～2.0 h,所有病例术后MR扫描示冰球完全覆盖病灶。术后2例患者出现发热,经对症处理后体温恢复正常。结论MR引导下氩氦刀冷冻消融术对骨盆肿瘤是一种安全、有效的治疗方式,并发症少,值得推广。     

经直肠超声引导经皮冷冻消融治疗寡转移前列腺癌疗效的初步分析

目的:评价经直肠超声引导经皮冷冻消融治疗寡转移前列腺癌(OPC)的疗效。方法:前瞻性收集2014年3月~2017年1月于我院行经直肠超声引导经皮冷冻消融治疗的16例OPC患者的临床病例资料并进行随访研究。所有患者在确诊后均行经直肠超声引导经皮冷冻消融治疗。随访时间12~28个月。研究主要终点为PSA有效率(PSA较治疗前下降≥50%)及完全有效率(PSA下降≥85%)。结果:9例患者术后3个月PSA下降≥50%,PSA有效率为56.2%,其中5例患者PSA下降≥85%,完全有效率为31.2%。随访期内2例患者出现PSA进展,PSA进展时间分别为16、18个月。所有患者术后均无明显并发症,仅1例患者出现下尿路症状(LUTS),2例患者出现排尿困难,保守治疗后好转。结论:经直肠超声引导经皮冷冻消融是OPC患者的有效治疗方式,具有疗效确切、并发症少、安全、微创等优点。但该技术目前尚处于起步探索阶段,缺乏对患者远期疗效的评估,因此需要进一步累计病例数及临床经验以得出明确结论。     

PRELIMINARY OUTCOMES FOLLOWING CRYOSURGICAL ABLATION OF THE PROSTATE IN PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CARCINOMA

Purpose

Cryosurgical ablation of the prostate is a novel therapeutic modality that induces cell lysis in the prostate by direct application of low temperatures. We have been conducting an ongoing prospective pilot study of the use of cryosurgical prostate ablation in treating patients with nonmetastatic prostate adenocarcinoma since January 1993. Results in 145 consecutive patients with mean 36 months and minimum 12 months of followup are presented.

Materials and Methods

Accrual was open to patients with clinical stages T1a to T3c prostate adenocarcinoma. Pelvic lymph node dissections were recommended but not required for patients with prostate specific antigen (PSA) greater than 15 ng./ml. before study entry. PSA changes, random prostate biopsy findings and morbidities after cryosurgical prostate ablation were recorded for each patient.

Results

Overall actuarial rates at 42 months for maintaining PSA less than 0.3 and less than 1.0 were 59% and 66%, respectively. The overall actuarial progression-free rate at 60 months was 56%. Among 160 biopsies performed 16% showed some evidence of residual carcinoma. Overall crude rates of maintaining either a negative biopsy or PSA less than 0.3 at 6 and 24 months after cryosurgical prostate ablation were 87% and 73%, respectively. Significantly higher morbidities were seen in previously radiated patients undergoing cryosurgical prostate ablation compared to those with no prior radiation. Among nonradiated patients 85% experienced no significant morbidity after cryosurgical prostate ablation.

Conclusions

Although preliminary, short-term outcomes after cryosurgical prostate ablation appear to be comparable to identical outcomes reported for external beam radiotherapy. Based on these results cryosurgical prostate ablation appears to be an effective therapeutic alternative for treating patients with localized prostate adenocarcinoma.     

Ultrasound probe positioning to minimize the risk of recto-urethral fistula during cryosurgical ablation of prostate cancer

OBJECTIVE: To evaluate the ability to increase the distance between the rectal mucosa and prostate, and thus decrease the risk of recto-urethral fistula, and to improve the ability to adequately freeze beyond the prostatic capsule during cryosurgical ablation for prostate cancer. PATIENTS AND METHODS: The transrectal ultrasound probe was manipulated to increase the distance from the rectal mucosa to prostate in 28 men scheduled for cryosurgical ablation for localized prostate cancer. Ten patients were treated for local recurrence after previous definitive radiotherapy, and cryosurgery was chosen as the primary treatment for the remainder. RESULTS: The mean (range) distance from the rectal mucosa to the prostate when the probe was securely applied to the rectal wall was 2.5 (1-7) mm, and could be extended to 9.6 (7-14) mm before the ultrasonogram quality diminished enough to impede accurate placing of the cryoprobe. The mean distance gained as a margin of error was 7.1 (4-12) mm (P < 0.001). In no patient was it felt that visualization during the freezing cycles was impaired. No recto-urethral fistula was identified. CONCLUSION: The manoeuvres described here allow the surgeon to freeze beyond the prostatic capsule while maintaining a visible distance from rectal wall. The extra distance created by this manoeuvre might reduce the risk of recto-urethral fistula, and potentially improve tumour control in the posterior aspect of the prostate, based on the ability to freeze beyond the capsule to reach lethal temperatures in all prostatic tissue.     

以前列腺特异抗原水平分组筛查与前列腺穿刺阳性率的关系

目的探讨不同血清前列腺特异抗原(PSA)水平前列腺癌检出情况以及直肠指诊(DRE)、经直肠超声检查(TRUS)、PSA密度(PSAD)等指标对筛查前列腺穿刺活检病例的意义。方法回顾性分析在1996年4月至2002年12月间行TRUS引导前列腺6点系统穿刺活检的634例患者的诊断资料,对各PSA组(≤4.0,4.1~,10.1~和>20.0μg/L组)中前列腺癌的检出率,以及PSA、DRE、TRUS、PSAD等对前列腺癌的预测作用进行t检验、χ2检验和多因素Logistic回归分析。结果PSA≤4.0,4.1~,10.1~和>20.0μg/L各组的前列腺癌检出率分别为11.6%(17/146),26.8%(38/142),39.8%(68/171)和68.6%(120/175)。PSA的敏感性最高(93.0%),特异性低(33.0%);DRE、TRUS等诊断效率较低。随血清PSA水平升高,前列腺癌检出率以及DRE、TRUS的阳性预测值逐渐升高;在PSA4.1~20.0μg/L者中,PSAD对前列腺癌有较大的预测价值(OR=687.09±646.96,P=0.000)。以PSAD≥0.13μg.L-1.cm-3为截点筛查前列腺穿刺病例,可在不明显降低敏感性的基础上,减少阴性穿刺。结论各PSA组国人与欧美等国前列腺癌检出率有较大差别;DRE、TRUS的筛查作用与血清PSA水平有关;按PSA水平分组筛查穿刺病例,可提高前列腺穿刺的阳性率。     

经会阴前列腺癌冷冻治疗的并发症及其防治

目的：探讨超声引导下经会阴前列腺癌靶向冷冻治疗的并发症及其防治。方法：对58例前列腺癌患者行超声引导下经会阴冷冻治疗,通过临床观察,分析其治疗后的并发症及原因。并总结防治措施。结果：尿失禁3～7天后恢复控尿16例（27．6％）;永久尿失禁2例（3．4％）;原有性交能力者18例中,术后出现勃起功能障碍12例（66．7％）;产生尿道腐肉3例（5．2％）;尿道直肠瘘、尿潴留、会阴部不适以及阴囊水肿各1例（1．7％）。结论：超声引导下经会阴前列腺癌靶向冷冻治疗的并发症发生率较低,且多数是可以预防和治疗的。     

超声引导下经直肠系统性12＋1针前列腺穿刺活检术

目的探讨超声引导下经直肠系统性12＋1针前列腺穿刺活检术诊断前列腺癌的临床价值。方法回顾性分析816例经直肠前列腺系统性12＋1针穿刺活检的可疑前列腺癌患者。其中PSA＜4ng／ml、直肠指诊发现结节者66例;PSA介于4～10ng／ml、f／tPSA值异常、PSAD值异常者190例;PSA〉10ng／ml、任何f／tPSA、PSAD值者560例。结果816例患者中活检病理确诊为前列腺癌者358例,总阳性率为43．9％（358／816）。其中位于前列腺尖部阳性者235例,占确诊病例总数的65．6％（235／358）。术后发热9例（1．0％,9／816）,并发血尿49例（6．0％,49／816）。几乎所有患者皆有短时大便带血。无其他严重并发症发生。结论超声引导下经直肠系统性前列腺12＋1针穿刺活检术定位准确,创伤较小,并发症较少。可以随机增加穿刺点,利于提高前列腺癌检出率。     

常规临床检查与PSA灰区患者前列腺癌检出率的关系

目的:探讨直肠指检(DRE)、影像学(TRUS、MRI)检查、血清游离与总前列腺特异性抗原(PSA)比值(f/t)与PSA在4～10μg/L之间患者前列腺癌检出率的关系。方法:回顾性分析365例PSA处于灰区的患者进行DRE、TRUS、MRI检查、游离PSA测定,并对这些患者行经直肠B超引导下的前列腺穿刺活检。评估其临床资料与前列腺穿刺病理结果的关系。结果:在365例患者中,穿刺病理为前列腺癌的患者共有87例(23.84%)。DRE阳性的患者共有128例,穿刺阳性40例,阳性率为31.25%,TRUS检查的患者共有257例,其中有异常回声结节的69例患者中穿刺阳性26例,阳性率为37.68%,MRI检查的患者共有191例,其中有异常信号结节的107例患者中穿刺阳性59例,阳性率为55.14%。198例患者行fPSA与tPSA比值分析,其中前列腺癌患者的平均f/t PSA明显低于穿刺阴性患者。f/t PSA受试者曲线(ROC)下的面积(0.725)高于患者PSA ROC的面积(0.542)。结论:结合临床DRE、影像学资料及f/t PSA比值可以有效提高前列腺癌检出率,从而减少不必要的穿刺给患者带来的痛苦。     

Single center experience with third-generation cryosurgery for management of organ-confined prostate cancer: critical evaluation of short-term outcomes, complications, and patient quality of life

BACKGROUND AND PURPOSE: Technical refinements such as improved ultrasonographic localization and the routine use of urethral warmers and small-gauge needle delivery systems have renewed interest in cryosurgical treatment as a minimally invasive option for selected patients with localized prostate cancer. Only three reports of quality of life (QoL) in prostate cryoablation exist, and none report on patients treated with third-generation cryoablative technology. We critically examine our initial series of consecutive patients at a single institution undergoing primary third-generation cryosurgical treatment of localized prostate cancer with respect to treatment outcome, morbidity profile, and QoL parameters. To our knowledge, this is the first QoL report on third-generation cryoablation of the prostate. PATIENTS AND METHODS: We retrospectively review the records of 89 consecutive patients with median followup of 11 months (1-32) who have undergone third-generation cryosurgical ablation of the prostate as primary treatment for localized prostate cancer with intention to cure. Patients were risk stratified according to preprocedural parameters of prostate-specific antigen (PSA), clinical stage, and Gleason score. PSA trends were recorded and treatment effectiveness was observed using different definitions of biochemical failure. Charts were reviewed for postprocedure complications. Quality of life was measured prospectively using the University of California, Los Angeles, Prostate Cancer Index as well as American Urological Association symptom scores. We compare a percent of baseline score (%BS) for various domains between our series of patients treated with primary cryoablation with a series of patients undergoing brachytherapy for localized prostate cancer. RESULTS: Treatment success was defined by achievement of a PSA nadir of < or =0.1 ng/mL and by biochemical disease-free survival (BDFS) assessed with both a PSA threshold of < or =0.4 ng/dL over time and the American Society for Therapeutic Radiology and Oncology (ASTRO) definition of three consecutive rises in PSA. According to risk stratification, 86%, 81.5%, and 78% of low-, intermediate-, and high-risk patients, respectively, achieved a PSA nadir of < or =0.1 ng/mL. Overall, at 12 months follow-up, 94% of patients achieved BDFS using ASTRO criteria while 70% achieved BDFS using a PSA threshold of < or =0.4 ng/mL. With risk stratification, 74%, 70%, and 60% of low-, intermediate-, and high-risk patients, respectively, achieved BDFS defined by PSA threshold of < or =0.4 ng/mL. Complications were rare. The response rate for Health Related Quality of Life (HRQoL) questionnaires was 71% for cryoablation patients and 51% for brachytherapy patients. At 12 months follow-up, patients undergoing cryoablation on average achieved urinary and bowel domain scores comparable to baseline, but sexual domains remained well below baseline. When compared with a brachytherapy series with better baseline sexual function (P = 0.04) and urinary function (P = 0.03), cryotherapy patients experienced more negative impact on sexual function steadily for up to 12 months (P = 0.02). Urinary function was similar between the groups until 18 months, at which time cryoablation patients fared better (P = 0.01); this was sustained up to 24 months (P = 0.04). CONCLUSIONS: Treatment success with cryosurgery varies with definition; however, our results are comparable to other series with regard to short-term cancer control. Complication rates in this series of third-generation cryosurgical patients are low. QoL characteristics of third-generation cryoablation are similar to those described in second-generation cryoablation series. Compared with brachytherapy, cryotherapy results in less irritative and obstructive voiding symptoms in the early post-treatment period and may improve urinary function up to 24 months after treatment. In a small group of older patients with baseline erectile dysfunction undergoing cryoablation, sexual function returns to 20% of its baseline value with up to 12 months follow-up.     

A prospective randomized trial comparing 6 versus 12 prostate biopsy cores: impact on cancer detection

PURPOSE: Several studies suggest that sextant transrectal ultrasound guided biopsy of the prostate provides insufficient material to detect all clinically important prostate cancer, and obtaining more biopsy cores may improve the cancer detection rate. We performed a prospective randomized trial comparing 6 to 12 prostate biopsy cores to determine the impact on the cancer detection rate. MATERIALS AND METHODS: We prospectively randomized 244 men, including 71 (29%) black men, with a mean age plus or minus standard deviation of 65 +/- 8 years to undergo biopsy with 6 or 12 peripheral zone tissue cores. In our study subjects serum total prostate specific antigen (PSA) was between 2.5 and 20 ng./ml., and/or digital rectal examination was suspicious for cancer. All men completed a self-administered pre-biopsy and 2 post-biopsy questionnaires at 2 and 4 weeks. Cancer detection rates were compared in the groups and correlated with race, biopsy history, digital rectal examination findings, total PSA, transrectal ultrasound volume and PSA density, as determined by the formula, total PSA/transrectal ultrasound volume. RESULTS: The cancer detection rate in the 6 and 12 core groups was almost identical (26% and 27%, p = 0.9). There was no significant difference in cancer detection in the 2 trial arms with respect to subject race, biopsy history, digital rectal examination findings, total PSA, transrectal ultrasound volume or PSA density. However, our study did not have the statistical power to rule out small differences. CONCLUSIONS: The overall cancer detection rate is not materially increased by 12 core, peripheral zone biopsy in men in whom prostate cancer was mainly detected by screening.