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目的 探讨血清PSA正常的进展性前列腺癌的诊断和治疗,提高对PSA正常的进展型前列腺癌的准确认识并提供临床正确诊治此类疾病的参考.方法 对3例病人的病历资料,进行回顾分析,并对PSA正常的进展型前列腺癌的原因发生机制进行探讨.结果 3例病人的PSA都小于2 ng/ml,病理证实均为前列腺癌.1例病人病情进展快,但2例联合全雄激素阻断和多西紫杉醇化学治疗能延长病人生存期.结论 血清PSA正常的前列腺癌诊断依赖于经直肠B超穿刺活检,治疗时应当注意联合多西紫杉醇化学治疗. 相似文献
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目的 探讨经会阴前列腺癌根治术在早期局限性前列腺癌治疗中的应用价值。方法 总结28例临床分期T1a~T2b前列腺癌患者经会阴前列腺癌根治术临床资料。经直肠B超引导下前列腺穿刺活检,证实为前列腺腺癌,Gleason评分2~4分13例,5~7分15例。血清PSA2.3~16.6ng/ml,平均9.2ng/ml。术前CT或MRI检查确定前列腺癌局限于前列腺包膜内,胸部、脊椎与骨盆X线平片、ECT均未发现远处转移灶。临床分期T1a~Tb3例,T1a5例,T213例,T2b7例。结合血清PSA、临床分期和GMason评分预测临床早期前列腺癌的病理分期均在T2内,28例均行经会阴前列腺癌根治术,未行盆腔淋巴结切除。结果 术后保留导尿5d,拔除导尿管后,23例患者控尿良好,4例患者有3~7d短暂的尿失禁。发生尿道直肠瘘1例,术后2个月瘘道自行愈合。术后病理:肿瘤局限于前列腺包膜内27例,有单侧包膜外浸润(T3a)1例。28例术后随访6~30个月。术后3个月PSA〈0.04ng/ml24例,1例〈0.01ng/ml,2例未检测到PSA。1例切缘阳性(T3a)、术后PSA持续升高者,行双侧睾丸切除。术后6个月20例同时复查胸部X线片和全身骨扫描,未发现远处转移病灶。结论 经会阴前列腺癌根治术治疗早期局限性前列腺癌在肿瘤控制和排尿控制方面有突出优势,结合PSA、临床分期和Gleason评分选择的病例,不需行盆腔淋巴结切除。 相似文献
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目的 观察前列腺癌患者完全性雄激素阻断治疗出现血清前列腺特异性抗原(PSA)升高后,停用氟他胺后PSA的变化。方法 78例前列腺癌患者,全雄阻断治疗PSA正常后若再次PSA〉4ng/ml,则停服氟他胺至少连续3月,观察PSA的变化情况。结果 (1)停服氟他胺后有42例PSA下降超过50%以上:(2)42例PSA下降超过50%以上者,19例停药后3月内达到,23例6月内达到;(3)23/42例停药6月内维持PSA〈4ng/ml,14/42例停药12月内维持PSA〈4ng/ml,5/42例维持12月以上:(4)42例患者中停药后PSA再次升高超过4ng/ml者,再次服用氟他胺后,9例PSA出现下降表现。结论前列腺癌患者在手术去势和氟他胺联合治疗后出现PSA上升者,在改用二线治疗前可先停用氟他胺。 相似文献
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目的探讨腹腔镜前列腺癌根治术的手术技巧和疗效。方法 2005年3月~2008年9月,经腹腔途径行腹腔镜前列腺癌根治术21例(T1a3例,T1b4例,T2a6例,T2b8例),游离膀胱前间隙、盆筋膜,显露前列腺尖部,缝扎阴茎背静脉复合体后离断膀胱颈,游离切除精囊,重建膀胱颈并与尿道吻合。结果 19例手术获得成功,中转开放手术2例,其中阴茎背静脉复合体损伤1例,直肠损伤1例。手术时间155~450min,平均280min;术中出血量170~2500ml,平均470ml。术后病理报告切缘阳性1例。术后尿管留置10~40d,平均14d,无真性尿失禁发生。术后发生漏尿3例,尿道狭窄1例,均治愈。21例随访5~44个月,平均18.5月,PSA0~5.85ng/ml,平均0.23ng/ml,未发现局部复发和远处转移。结论腹腔镜前列腺癌根治术是治疗局限性前列腺癌的安全有效措施。熟练掌握盆腔解剖,预先处理阴茎背静脉复合体,膀胱颈重建和镜下吻合技术是成功实施手术的关键。 相似文献
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腹腔镜前列腺癌根治术(附11例报告) 总被引:1,自引:0,他引:1
目的探讨腹腔镜前列腺癌根治术的应用价值。方法4例采用经腹腔途经,7例采用经腹膜外途经,手术切除前列腺、精囊、输精管壶腹,行膀胱尿道吻合。结果11例手术均获得成功,手术时间180~390min,平均304min。术中出血量300~1200ml,平均520ml。术后留置尿管时间12~28d,平均19.8d。无直肠损伤等并发症。术后住院时间12~24d,平均20d,无尿失禁及尿道狭窄。11例随访1~36个月,平均11个月,未发现肿瘤局部复发和远处转移,术后3个月前列腺特异抗原0~0.05μg/L。结论腹腔镜前列腺癌根治术是一种安全、有效的治疗方法。 相似文献
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腹膜外径路腹腔镜前列腺癌根治术(附65例报告) 总被引:7,自引:7,他引:0
目的:探讨腹膜外径路腹腔镜PCa根治术的初步体会。方法:经腹膜外径路进行腹腔镜PCa根治术65例。结果:64例(98.5%)成功,手术时间100~440min,平均172min。出血量150~800ml,平均340ml,7例(10.8%)患者输红细胞悬液2~4U。1例术中发生直肠损伤,2例术后发生尿外渗。6例(9.2%)患者术后病理提示切缘阳性。58例(89.2%)患者术后3个月尿控良好。结论:腹膜外径路腹腔镜PCa根治术是安全、可行的。且因避免了术中、术后对腹腔内肠管的干扰,降低了手术并发症,利于术后患者的恢复,值得在临床推广应用。 相似文献
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目的探讨腹膜外途径腹腔镜前列腺癌根治术的临床效果。方法回顾性分析总结2009年5月至2011年7月经腹膜外径路进行腹腔镜前列腺癌根治术患者12例,年龄60~75岁,平均年龄68岁。血清前列腺特异性抗原(prostate specific antigen,PSA)为0.7~23.6ng/ml。TNM分期T1N0M08例,T2N0M03例,T3aN0M01例。所有患者均于术前行前列腺穿刺活组织检查,证实为前列腺癌。结果 12例患者均顺利完成手术,手术时间为130~360min,平均270min;术中出血量为150~900ml,平均390ml,1例患者术中输血。术后病理检查结果显示肿瘤切缘为阳性的2例患者术后加用全雄激素阻断治疗3个月。术后留置尿管时间14~22d,平均18.6d,无直肠损失病例,3例术后出现轻度尿失禁的患者经提肛训练等辅助治疗3个月后好转,能自主排尿。术后3个月时PSA为0.02~0.10ng/ml,术后随访8例,随访时间为3~24个月,未发现肿瘤局部复发和远处转移。结论腹膜外径路腹腔镜前列腺癌根治术视野清晰、创伤小、恢复快,是一种安全、有效的治疗方法,值得临床推广。 相似文献
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对前列腺癌根治性治疗后生化复发的认识及对策 总被引:1,自引:0,他引:1
随着血前列腺特异性抗原(PSA)检测的广泛应用,前列腺癌的检出率及早期病变检出率显著上升,患者发病年龄趋于年轻化,越来越多局限性病变患者适合行根治性治疗:根治性前列腺切除术(RP)或放疗(RT)。美国1996年超过75%的前列腺癌患者表现为临床局限性肿瘤,因此RP及RT所占比例稳步上升,分别约占1/3。目前我国仍以RP为主。 相似文献
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前列腺特异性抗原与前列腺癌 总被引:7,自引:0,他引:7
前列腺特异性抗原(prostate-specific antigen,PSA)是一种糖蛋白,主要由前列腺腺泡和导管上皮细胞合成。在正常生理条件下,它主要局限于前列腺组织内,血清中PSA浓度很低。前列腺导管系统周围环境的正常屏障作用防止高浓度PSA外泄到细胞间隙,维持了血循环中PSA的低浓度。前列腺疾病所致的前列腺正常组织的破裂会使大量的PSA进入机体的血液循环,升高的血清PSA成为前列腺病理改变的重要标记物。目前血清PSA已被广泛用于前列腺癌的诊断、分期及治疗后监测,是前列腺癌早期筛查的重要指标。一、PSA与前列腺癌的早期筛查在欧美,前列腺癌… 相似文献
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Therapeutic Efficacy of Clenbuterol for Urinary Incontinence after Radical Prostatectomy 总被引:1,自引:0,他引:1
Masanori Noguchi Yoshiro Eguchi Junji Ichiki Junro Yahara Shinshi Noda 《International journal of urology》1997,4(5):480-483
Background :
Urinary incontinence is one of the most common complications occurring after radical prostatectomy. We evaluated the efficacy of clenbuterol, a selective β2 -adrenoceptor agonist, in the treatment of incontinence occurring after radical prostatectomy, using urodynamic assessment.
Methods :
Fourteen men (mean age, 68 years) with post-radical-prostatectomy incontinence were treated with 20 mg of clenbuterol twice a day for 1 month. The urodynamic assessment was performed on all patients before and after the administration of clenbuterol. A pad scoring system was used to gauge the severity of incontinence before and after treatment.
Results :
At 1 month after administration of clenbuterol, 9 of the 14 patients (64%) had dramatic improvement in pad scores. Treatment failed in 5 patients (36%) with severe incontinence. The results of urodynamic studies showed that the mean functional urethral length of the patients with post-radical-prostatectomy incontinence increased significantly after treatment.
Conclusion :
These results suggest that clenbuterol can be used as an effective agent for treating mild-to-moderate stress incontinence after radical prostatectomy. 相似文献
Urinary incontinence is one of the most common complications occurring after radical prostatectomy. We evaluated the efficacy of clenbuterol, a selective β
Methods :
Fourteen men (mean age, 68 years) with post-radical-prostatectomy incontinence were treated with 20 mg of clenbuterol twice a day for 1 month. The urodynamic assessment was performed on all patients before and after the administration of clenbuterol. A pad scoring system was used to gauge the severity of incontinence before and after treatment.
Results :
At 1 month after administration of clenbuterol, 9 of the 14 patients (64%) had dramatic improvement in pad scores. Treatment failed in 5 patients (36%) with severe incontinence. The results of urodynamic studies showed that the mean functional urethral length of the patients with post-radical-prostatectomy incontinence increased significantly after treatment.
Conclusion :
These results suggest that clenbuterol can be used as an effective agent for treating mild-to-moderate stress incontinence after radical prostatectomy. 相似文献
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目的总结腹腔镜前列腺癌根治术的经验。方法2004年9月~2005年12月,我科对8例早期局限性前列腺癌行经腹腔腹腔镜前列腺癌根治术,游离前列腺直肠间隙达前列腺尖部,游离膀胱前间隙及耻骨后间隙,缝扎阴茎背深静脉后离断膀胱颈部,重建膀胱颈并与尿道吻合。结果8例腹腔镜前列腺癌根治术均获成功,无一例中转开放手术。手术时间270~420min,平均325min;术中出血量300~1600ml,平均580ml,其中1例由于术中损伤阴茎背深静脉大出血1600ml,需要输血4例。标本切缘阳性1例。术后膀胱尿道吻合口尿漏2例;术后2周拔除导尿管,出现尿失禁2例,1例尿失禁在随访6个月后尿控能力恢复,另1例尿失禁仍存在。8例术后随访10~24个月,平均16个月,排尿均通畅,未出现生化复发现象。结论熟悉前列腺的局部解剖、有良好的腹腔镜器械辅助及熟悉掌握各种腹腔镜下操作技术是开展此手术的关键。 相似文献
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Cabir Alan Ali E. Eren Ahmet R. Ersay Hasan Kocoglu Gokhan Basturk Emrah Demirci 《Current Urology》2015,8(1):43-48
Aim
To evaluate the efficacy of early duloxetine therapy in stress urinary incontinence occurring after radical prostatectomy (RP).Material and Method
Patients that had RP were randomly divided into 2 groups following the removal of the urinary catheter. Group A patients (n = 28) had pelvic floor exercise and duloxetine therapy. Group B patients (n = 30) had only pelvic floor exercise. The incontinence status of the patients and number of pads were recorded and 1-hour pad test and Turkish validation of International Consultation on Incontinence Questionnaire-Short Form test were applied to the patients at the follow-up.Results
When the dry state of the patients was evaluated, 5, 17, 3, and 2 of 28 Group A patients stated that they were completely dry in the 3rd, 6th, 9th and 12th month respectively and pad use was stopped. There was no continence in 30 Group B in the first 3 months. Twelve, 6, and 8 patients stated that they were completely dry in the 6th, 9th and 12th month, respectively. But 3 of 4 patients in whom dryness could not be provided were using a mean of 7.6 pads in the first day and a mean of 1.3 pads after 1 year. When pad use of the patients was evaluated, the mean monthly number of pad use was determined to be 6.2 (4-8) in the initial evaluation, 2.7 (0-5) in the in 3rd month, 2 (0-3) in the 6th month and 1.6 (0-2) pad/d in the 9th month in the group taking medicine. The mean monthly number of pads used was determined to be 5.8 (4-8) in the initial evaluation, 4.3 (3-8) in the 3rd month, 3 (0-6) in the 6th month and 1.6 (0-6) pad/d in the 9th month in the group not taking medicine.Conclusion
According to the results, early duloxetine therapy in stress urinary incontinence that occurred after RP provided early continence.Key Words: Duloxetine, Urinary continence, Radical prostatectomy 相似文献15.
目的 探讨保护控尿功能的前列腺癌根治术的技术要点.方法 对收治的94例T1b~T2c前列腺癌患者行保留控尿功能的前列腺癌根治术,即腹腔镜下精细解剖前列腺尖部,保护EUS及其控尿神经,膀胱颈后唇成形后与尿道吻合;并同前期42例行常规前列腺癌根治术(LRP)的患者比较,术后30、60和90 d评估患者的控尿状况.控尿标准: 站立或行走时无尿液漏出,或全天使用尿垫不超过1块.结果 术后30、60 d控尿率LRP组为27.7%(13/47)、66.0%(31/47);CSLRP组为55.3%(26/47)、85.1%(40/47),均有统计学差异(χ2=7.406,4.663,P<0.05).术后90 d两组控尿率为78.7%(37/47)和91.5%(43/47)(χ2=3.02,P>0.05).结论 利用腹腔镜的优点,保护EUS和膀胱颈后唇成形加强尿道后壁,能明显加快前列腺癌根治术后控尿的恢复时间. 相似文献
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目的:探讨耻骨后根治性前列腺癌切除术手术方法和技巧。方法:回顾性分析我院自2006年1月-2008年5月施行的前列腺癌根治术31例。结果:全部病例术后恢复顺利,3周后拔除导尿管。1例出现压力性尿失禁;3例术后6周出现排尿困难,2例经尿道扩张后缓解,1例因不愿行尿道扩张而自愿要求膀胱造瘘;6例远端或两端切缘阳性予以辅助放疗和内分泌治疗,随访3-27个月无生化复发。结论:耻骨后根治性前列腺癌切除术是治疗早期前列腺癌的有效方法,是腹腔镜前列腺癌根治术的有力保证。 相似文献
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Hugh J. Lavery Shiv Patel Michael Palese Nabet G. Kasabian Daniel M. Gainsburg David B. Samadi 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2010,14(4):603-607
A 60-year-old man with prostatic adenocarcinoma and an enhancing left-sided renal mass underwent successful combined robotic radical prostatectomy and robotic radical nephrectomy. We describe the initial report of this combined robotic procedure to remove 2 synchronous urological malignancies and describe our technique. An analysis was conducted of the operating room and postanesthesia care unit charges of this procedure compared with the 2 procedures performed independently. 相似文献
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