前列腺癌^125I粒子植入治疗对下尿路症状的影响（附70例报道）

目的探讨前列腺癌^125I粒子植入治疗后下尿路症状的变化规律，为临床治疗提供参考。方法接受^125I粒子植入治疗的前列腺癌患者72例，失访2例，随访70例，年龄58～85岁，平均年龄（73．6±10．4）岁。临床分期T1bNoMo～T3bNoMo。治疗前PSA0．4～55．2ng／mL，Gleason评分6～9分，前列腺体积19mL～59mL。国际前列腺症状评分（IPSS评分）5～21分，平均14分。植入粒子30～90粒，平均活度0．38mCi，总活度平均27．22mCi；植入针12～23根。术前1周至术后6个月常规使用α-肾上腺能受体阻滞剂。观察治疗后下尿路症状的变化。结果70例随访3～72个月，中位随访时间29．3个月。出院后无急性尿潴留发生；轻度尿失禁2例（2．9％），均在术后2～4个月好转。出现尿频、尿急及排尿困难或加重65例（92．9％）。术后0．5、1、2、3、6、9、12、18、24个月出现尿频、尿急及排尿困难或加重者分别为34．3％、85．7％、92．9％、82．8％、45．7％、28．6％、17．1％、8．5％、2．8％。下尿路症状持续时间与治疗前IPSS评分成正相关，P值为0．007。结论前列腺癌^125I粒子植入治疗后下尿路症状常见，持续时间较长，但不严重，大多数可恢复。持续时间与治疗前IPSS评分相关，使用α-肾上腺能受体阻滞剂可以有效缓解症状并避免手术干预。

Effect of lower urinary tract symptoms after brachytherapy for prostate cancer(Report of 70 cases)

Objective To evaluate the changes of lower urinary tract symptoms （LUTS） after prostate cancer brachytherapy. Methods 72 patients with prostate carcinoma underwent ^125I seed implantation. 70 patients got follow-up. All patients were at clinical stage TlbNoMo-T3bNoMo with Gleason scores 6 to 9, serum PSA （0.4-55.2） ng/ ml, prostate volume 19-59 ml. 30-90 seeds were implanted by 12-23 needles with seed activity mean 0.38 mCi, total seed activity mean 27.22 mCi. International prostate symptom scores （IPSS） ranged from 5 to 21, with mean of 14. All the patients received a-blocker therapy. Results Patients were followed-up for 3-72 months （mean 29 months）. No acute urinary retention was found and mild urinary incontinence was found in 2 cases （2.9%）. During the follow-up, 65 （92.9%） of them had LUTS or LUTS symptoms aggravated. Percentages of patients with LUTS after brachytherapy at different time point were as follow： 15d, 34.3%; lmonth, 85.7%; 2months, 92.9%; 3months, 82.8%; 6months, 45.7%; 9months, 28.6%; 12 months, 17.1% ; 18 months, 8.5 % ; 24 months, 2.8 %, respectively. Higher IPSS before brachytherapy were correlated with LUTS lasting time. Conclusion LUTS after prostate cancer brachytherapy is common and long lasting, but not serious, which could be relieved by alpha-blockers.