改良 Madigan 前列腺切除术在临床的应用(附53例报告)

为了提高前列腺切除术的治疗效果，１９９３年９月～１９９６年５月对５３例前列腺增生症患者采用改良Ｍａｄｉｇａｎ前列腺切除手术。术前留置尿管后作ＣＴ检查，按ＣＴ测量前列腺体积计算重量并分度，了解尿道走向。手术特点为锐性分离前列腺与尿道、膀胱颈之间的组织及前列腺包膜，切除增生的腺体组织，保留完整尿道与膀胱颈。术后恢复快，并发症少，随访１～３２个月，疗效满意。对手术操作要点及适应证进行了讨论。     

耻骨后保留尿道前列腺切除术67例报告

报告采用经耻骨后保留尿道前列腺切除术治疗前列腺增生６７便，术后随访３￣１８个月，疗效满意，认为本手术具有不损伤尿道，术后恢复快，并发症少，保留顺行射精，简单易行等优点，适用于除外前列腺纤维化，前列腺肿瘤的前列腺增生患者。     

Madigan前列腺增生切除术

为了提高前列腺增生症的手术治疗效果，采用Ｍａｄｉｇａｎ手术治疗前列腺增生症患者２５例。１５例尿道完整，１０例损伤尿道缝合修复；术后出血少、恢复快；随访４～２５个月，无尿道狭窄、尿失禁等并发症。对手术优点、术中注意事项及适应证的选择进行了讨论。     

经尿道前列腺电汽化切除术

１９９６年１２月－１９９７年１２月，对１００例良性前列腺增生症行经尿道前列腺电汽化芬除术。术后随访１－１２个月，患者在尿流率，国际前列腺症状，生活质量评分，剩余尿等方面均有显著改善。ＴＵＶＰ兼有经尿道前列腺电切及经尿道前列腺激光治疗的优点，具有操作简便，去除增生组织量大，出血少，并发症低，恢复快，疗效显著等特点，是值得推广的新方法。     

经尿道绿激光瘢痕汽化术治疗良性前列腺增生术后后尿道狭窄

目的研究采用绿激光在膀胱尿道软镜配合下治疗前列腺增生术后后尿道狭窄的临床疗效。方法使用绿激光对前列腺增生术后后尿道狭窄的患者18例进行经尿道绿激光瘢痕汽化术,所有患者术前经膀胱尿道软镜检查确诊。其中前列腺摘除术后10例,经尿道前列腺电切术后8例。术后留置尿管1周至1个月。结果 18例患者手术均一次性成功,手术时间25～90min,平均67min,随访2～8个月,15例患者术后即治愈,其余3例患者经多次定期尿道扩张后4～8个月内治愈,无尿失禁患者出现。结论绿激光治疗前列腺增生术后后尿道狭窄安全有效。     

同期行经尿道电切术治疗膀胱癌并前列腺增生的临床观察

目的：探讨膀胱癌并前列腺增生患者同期行经尿道膀胱肿瘤加前列腺电切术的可行性。方法：回顾性分析46例膀胱癌并前列腺增生患者的手术方法，26例同期行经尿道膀胱肿瘤加前列腺电切术（A组），20例单纯行经尿道膀胱肿瘤电切术（B组）。结果：随访12－40个月，A组有3例术后复发，复发时间为术后18．4个月，无尿道及前列腺窝转移；B组有4例术后复发，复发时间为术后15．4个月，5例随访期内因前列腺增生再次行经尿道前列腺电切术。结论：膀胱肿瘤并前列腺增生患者同期行经尿道电切术可减少经费，缩短住院时间。     

耻骨上经膀胱保留后尿道前列腺切除术（附32例报告）

报告３２例耻骨上经膀胱保留后尿道前列腺时除术治疗良性前列腺增生症。手术顺利，手术时间平均４２分，术中平均出血４０ｍｌ，切除腺体平均５２．４ｇ，术后无出血、感染、尿失禁等并发症，随访半个月～２３个月，排尿通畅，剩余尿０～３０ｍｌ，平均最大尿流率＞１８ｍｌ／ｓ。认为该术式保留了完整的尿道连续性，术后恢复快，并有操作简便，出血少，并发症少等特点。对术中操作要领，适应证等进行了讨论。     

改良Madigan前列腺切除术在临床的应用

为了提高前列腺切除术的治疗效果，１９９３年９月－１９９６年５月对５３例前列腺一症患者采用改良Ｍａｄｉｇａｎ前列腺切除手术。术前留置民管后作ＣＴ检查，按ＣＴＩ有列腺体积计算重并发分长，了解尿道走向，手术特点为锐性分离前列腺与尿道、膀胱颈之间的组织及前列包膜，切除增生的腺体组织，保留完整尿道与膀胱颈。术后恢复快，并发症少，随１－３２个月，疗效满意。对手术操作要点及适应证进行了讨论。     

个体化改良术式防止前列腺癌根治术后尿失禁

目的：探讨前列腺癌根治术中保护控尿功能的方法。方法：对51例临床局限性前列腺癌患者(TNM分期为T1a～3hN0M0)，采用个体化改良术式行耻骨后根治性前列腺切除术，术中为保留控尿功能仔细解剖前列腺尖部并作无张力膀胱颈一尿道残端吻合。结果：术后12～14d拔除尿管时22例(43．1％)控尿满意，术后1个月45例(88．2％)控尿满意．术后3个月至今，所有患者控尿满意。平均随访14个月(3～24个月)，随访期间无生化复发及尿道狭窄发生。结论：术中注意以下几点可提高耻骨后根治性前列腺切除术后的控尿功能：①良好控制背静脉丛以获得无血手术视野；②在保证尖部切除范围前提下，尽量延长功能性尿道长度；③根据术中具体解剖情况再造膀胱颈口；④膀胱黏膜外翻并与尿道残端无张力吻合(7针或9针缝合法)，减少术后漏尿及尿道狭窄发生。     

经尿道前列腺电切术后常见并发症的总结

目的探讨经尿道前列腺切除术后常见并发症的原因、预防和处理方法。方法经尿道前列腺电讪小治疗良性前列腺增生症65例，出现并发症8例，对其临床资料进行分析。结果术中严重出血1例，中转开放手术治愈。尿潴留2例，1例再次行前列腺电切术后排尿通畅，1例作尿道扩张术及口服对症药物治疗后排尿正常。尿道狭窄4例，定期尿道扩张1个月，排尿顺畅。尿失禁1例，用阴茎夹控制排尿。结论严格掌握手术指征，术中认真止血，尽可能切除前列腺，避免损伤尿道膜部括约肌是预防上述并发症的关键。     

Prostatic adenocarcinoma with endometrioid features. Clinical, pathologic, and ultrastructural findings

Thirteen cases of prostatic adenocarcinoma with endometrioid features were reviewed. The patients were older men (49-81 years) presenting with symptoms of hematuria and urinary obstruction. Each of the tumors displayed exophytic growth into the prostatic urethra, with involvement of the verumontanum. The urethral orifices of the large (primary) prostatic ducts were uniformly involved, and coexistent invasive (acinar) adenocarcinoma was identified in 10 cases (77%). The tumors exhibited a complex glandular pattern strikingly similar to uterine endometrial carcinoma, with prominent papillary formation in six cases. All cases demonstrated intense cytoplasmic immunoreactivity for prostatic acid phosphatase and prostate-specific antigen in at least part of the tumor. Focal staining for carcinoembryonic antigen was seen in three cases. Five tumors examined ultrastructurally demonstrated typical features of prostatic adenocarcinoma. Follow-up information was available on all 13 patients (6-83 months). Seven patients died of metastatic tumor (9-70 months after diagnosis), and the other six patients exhibited recurrent local or metastatic tumor. The sites of metastases were identical to those seen with invasive "acinar" prostatic adenocarcinoma, including pelvic lymph nodes, bones, and lungs. Crude 5-year survival was 15%, with a mean survival of 37 months. Adjuvant therapy provided palliative relief for many patients, but did not appear to influence survival. These findings indicate that endometrioid carcinoma is a histologically distinct variant of prostatic adenocarcinoma, with a more aggressive clinical behavior than previously thought.     

The influence of reversible androgen deprivation on serum prostate-specific antigen levels in men with benign prostatic hyperplasia

This study was designed to investigate the relationship of serum prostate-specific antigen to prostatic size and hormonal stimulation. Seven patients with benign prostatic hyperplasia were treated for six months with nafarelin acetate and then followed for an additional six months. Nafarelin acetate is a potent luteinizing-hormone-releasing hormone agonist which causes reversible testosterone deprivation resulting in involution of the prostate. During therapy and follow up, serum prostate-specific antigen correlated with: 1) serum testosterone (p less than 0.001); 2) quantity of prostatic epithelium (p less than 0.001); and 3) prostatic size (p less than 0.05). Before therapy, serum prostate-specific antigen (mean +/- SD) was 0.43 +/- 0.2 ng./ml. per gram of epithelium. This did not change significantly after six months of androgen deprivation (0.48 +/- 0.36), although the ratios of prostate-specific antigen to testosterone and to prostatic size each changed significantly. Despite testosterone levels in the castrate range at six months, five of seven patients had serum prostate-specific antigen concentrations above the female range and three of seven patients had prostatic biopsies containing columnar epithelium which stained positively for prostate-specific antigen. These results demonstrate that serum prostate-specific antigen is related to prostatic size, prostatic epithelial weight, and testosterone stimulation. However, prostatic size is not a good predictor of serum prostate-specific antigen because there is tremendous variation in the relative amount of epithelium in a prostate; in this study the ratio of prostatic size to epithelial weight varied threefold. Furthermore, although testosterone determines prostatic size and amount of prostatic epithelium, it may not totally control prostate-specific antigen production.     

临床评估同时切除前列腺和膀胱肿瘤对膀胱肿瘤复发的影响(附47例报告)

目的：评估同时切除前列腺和膀胱肿瘤对膀胱肿瘤在膀胱颈部和（或）前列腺窝处复发的影响。方法：回顾性研究47例同时行经尿道膀胱肿瘤电切术和经尿道前列腺切除术的患者,分为膀胱肿瘤单发组26例和多发组21例,记录随访时间、肿瘤的复发时间、复发位置、复发数量以及肿瘤的进展,综合评价同时切除前列腺搜膀胱肿瘤和膀胱肿瘤复发的关系。结果：所有患者随访1～4年,平均随访2、9年;膀胱肿瘤的平均复发率为68.1%,单发组复发率为53.8％,多发组复发率为85.7％,两组复发率差异有统计学意义（P〈O．05）;肿瘤平均复发时间15.1个月,单发组复发时间17.5个月,多发组复发时间12.4个月;在膀胱颈和（或）前列腺窝肿瘤复发10例（21.3%）：在前列腺窝膀胱肿瘤平均复发时间为21.3个月,在单发组为26.O个月,而在多发组为20.6个月。3例患者（6.3％）最后发展为浸润性膀胱癌而行膀胱全切术。结论：同时切除前列腺和膀胱肿瘤是一种比较安全的手术策略,对膀胱肿瘤在膀胱颈和前列腺窝处的复发没有影响。     

膀胱癌合并前列腺增生的一期开放切除术（附14例报告）

采用一期开放切除术治疗膀胱癌合并前列腺增生症１４例，效果满意。１４例中初发肿瘤８例，复发肿瘤６例。术后随访９一１０４个月，平均５１．３个月，无１例膀胱肿瘤复发，也未发现前列腺窝有肿瘤种植。主张同期切除，就其理由及适应证进行讨论。     

Successful complete androgen blockade (CAB) therapy for prostatic cancer detected from multiple lung metastases: a case report

Prostatic cancer is rarely diagnosed by detection of lung metastases. We report a case of prostatic cancer in a 73-year-old man detected by abnormalities in chest X-ray and serum prostate specific antigen (PSA) level. He was initially admitted to our hospital due to elevation of PSA level. On the first transperineal prostatic needle biopsy, prostatic cancer was not detected and he was followed. Seven months after the first biopsy, chest X-ray revealed multiple abnormal nodules in the lung fields bilaterally and PSA level was again elevated. A second prostatic biopsy and whole-body examination were performed, and he was diagnosed with moderately differentiated prostatic adenocarcinoma with multiple lung metastases. Complete androgen blockade therapy was performed immediately. Two months after the beginning of treatment, PSA level was normalized and the multiple lung metastases had completely disappeared. There has been no evidence of recurrence or PSA relapse 24 months after detection of the prostatic cancer. This is the 26th case of prostatic cancer diagnosed in Japan following detection of multiple lung metastases.     

Mucinous adenocarcinoma of the prostate with good response to hormonal therapy: a case report]

A 79-year-old man complained of pollakisuria and sense of retention. The prostate was stony hard and heterogeneously enhanced on computed tomographic (CT) scan. The serum levels of prostatic specific antigen, prostatic acid phosphatase and gamma-Seminoprotein were abnormally high. Prostatic biopsy showed mucinous adenocarcinoma which was stained by prostatic specific antigen. Bone scintigraphy revealed multiple metastases. Hormonal therapy was performed. Each prostatic tumor marker decreased to the normal range within 2 months. After 3 months, the prostate was almost normalized on digital examination and CT scan. There were no new metastases, prostatic biopsy revealed that most cancer cells had degenerated to nonviable cells and bone metastases had decreased.     

The efficacy of norfloxacin in the treatment of chronic bacterial prostatitis refractory to trimethoprim-sulfamethoxazole and/or carbenicillin

We treated 15 men who had chronic bacterial prostatitis refractory to trimethoprim-sulfamethoxazole and/or carbenicillin with 400 mg. norfloxacin twice daily for 28 days. All pathogens were susceptible to norfloxacin and absent in prostatic fluid cultures obtained during therapy. One patient had negative post-therapy prostatic fluid cultures but was lost to followup at 1 month. Of the 14 patients followed for at least 6 months 9 (64%) were cured of the original infection, including 6 who have remained uninfected and have had negative prostatic secretion and urine cultures for at least 2 years (1), 1 year (2) or 6 months (3). In 3 patients urinary tract infections recurred with new pathogens at 6, 560 and 820 days after post-therapy negative prostatic fluid cultures. Bacterial prostatitis with the original pathogen recurred in 5 patients within 2 months of completing therapy. The bacteria remained susceptible to norfloxacin but could not be eradicated with 30 to 90 days of additional norfloxacin therapy. Cures were achieved in 9 of 12 patients with Escherichia coli, none of 2 with Pseudomonas prostatitis and 3 of 5 with prostatic calculi. No patient experienced significant adverse effects. The data suggest that norfloxacin is effective and safe for the treatment of refractory chronic bacterial prostatitis.     

前列腺增生经尿道汽化切割与电切术的疗效比较

目的 :比较经尿道前列腺汽化切割 (TUVP)与电切术 (TURP)治疗良性前列腺增生 (BPH)病人的疗效。　方法 :2 0 6例BPH病人 (术前估计前列腺重量≤ 6 0 g)被随机分成TUVP(97例 )和TURP(10 9例 ) 2组 ,对病人进行为期 12～ 34(平均 2 0 )个月的随访。　结果 :2组术后第 12、2 4个月国际前列腺症状评分 (I PSS)均较术前下降 (P<0 .0 1) ,膀胱残余尿 (PVR)均较术前减少 (P <0 .0 1) ,最大尿流率 (Qmax)均较术前升高 (P <0 .0 1)。　结论 :TUVP和TURP对增生≤ 6 0g的BPH病人均有良好的治疗作用。TUVP较TURP能缩短手术时间和术后置管时间     

缓退瘤治疗前列腺癌

目的：探讨缓退瘤（Ｆｌｕｔａｍｉｄｅ）与手术或药物去势联合治疗前列腺癌的疗效。方法：回顾性分析１８例手术或药物去势联合缓退瘤治疗的前列腺癌患者的临床资料。结果：病理确诊后１４例行手术去势及缓退瘤治疗,４例行药物去势加缓退瘤治疗,１６例获得显著效果,１例出现肝功能损害,１例出现缓退瘤撤除综合征。     

Pre-treatment and post-treatment evaluation of prostatic adenocarcinoma for prostatic specific acid phosphatase and prostatic specific antigen by immunohistochemistry

Prostatic specific acid phosphatase and prostatic specific antigen have been used as specific markers of prostatic adenocarcinoma in immunohistochemical studies, particularly when seeking the primary site of a poorly differentiated metastasis. We herein evaluate the effect of therapy on the persistence of these markers in surgically obtained tissues. Prostatic biopsies from 30 patients with adenocarcinoma of the prostate gland before and after treatment with orchiectomy alone, diethylstilbestrol, external beam radiation or combined radiation and diethylstilbestrol were studied for prostatic specific acid phosphatase and prostatic specific antigen using the indirect immunoperoxidase technique. The interval between biopsies ranged from 3 to 72 months, with an average of 28 months. All pre-treatment biopsies stained positively for prostatic specific acid phosphatase and prostatic specific antigen. Staining for prostatic specific antigen and prostatic specific acid phosphatase was seen easily in 29 of 30 post-treatment biopsies, while in 1 case infiltrating anaplastic cells surrounded by stroma showed staining for these antigens in an extremely small percentage of cells, which were overlooked easily unless examined carefully. In view of this small number of positively staining cells this case was designated as equivocal. While some cases demonstrated less intense staining in post-treatment biopsies compared to pre-treatment, this finding was by no means constant. With these primary antisera a higher percentage of cytologically malignant cells stained positively for prostatic specific acid phosphatase than for prostatic specific antigen in adjacent tissue sections in some cases. Prostatic specific acid phosphatase and prostatic specific antigen appear to be sensitive and persistent markers of prostatic adenocarcinoma despite morphologic changes accompanying various therapies.