经尿道前列腺等离子电切术联合内分泌疗法治疗晚期前列腺癌合并膀胱出口梗阻的临床疗效观察

目的观察经尿道前列腺等离子电切术(pPKRP)联合内分泌疗法治疗晚期前列腺癌合并膀胱出口梗阻的临床效果,并评价其临床应用价值。方法选择2013年2月至2017年12月期间在本院接受治疗的80例晚期前列腺癌合并膀胱出口梗阻患者作为研究对象,根据治疗方法不同将其分为两组,对照组(n=37)单纯给予最大限度雄激素阻断治疗,包括药物去势(皮下注射醋酸亮丙瑞林微球3.75 mg,每月1次)+口服比卡鲁胺50 mg/d,试验组(n=43)在对照组基础上加用PKRP术,比较两组患者治疗前和治疗后的最大尿流量(Qmax)、残余尿量(PVR)、前列腺特异性抗原(PSA)、前列腺体积、国际前列腺症状评分(IPSS)、生活质量评分(QOL)。结果试验组治疗后的Qmax、PSA、前列腺体积、IPSS、QOL大于对照组,PVR小于对照组(P<0.05);随访10~22个月,试验组15例患者病情出现进展,5例死亡,对照组有12例患者病情出现进展,4例死亡,两组患者的病情进展率、病死率差异无统计学意义(P>0.05);试验组出现电切综合征2例、术后出血4例、术后尿道狭窄1例,经对症治疗后均明显改善。结论PKRP术联合内分泌疗法治疗晚期前列腺癌合并膀胱出口梗阻的短期疗效显著,能够明显改善患者的前列腺功能和临床症状,提高患者生存期的生活质量,具有较高的临床实用价值。

Clinical observation of plasma kinetic resection of prostate combined with endocrine therapy in the treatment of advanced prostate cancer with bladder outlet obstruction

Objective To observe the clinical effect of plasma kinetic resection of prostate(PKRP)combined with endocrine therapy in the treatment of advanced prostate cancer complicated with bladder outlet obstruction,and to evaluate its clinical application value.Methods From February 2013 to December 2017 in our hospital for treatment of 80 cases of patients with advanced prostate cancer with bladder outlet obstruction as the research object,according to different treatment were divided into two groups,control group(n=37)simply underwent maximum androgen deprivation therapy,including drug castration(subcutaneous injection of 3.75 mg,leuprolide acetate microspheres 1 time a month)+oral administration of bicalutamide 50 mg/d,experimental group(n=43)in the control group basis underwent PKRP treatment.Qmax,PVR,PSA,prostate volume,IPSS,and QOL were compared between the two groups before and after treatment.Results The Qmax,PSA,prostate volume,IPSS and QOL of the experimental group after treatment were larger than those of the control group,and the PVR was smaller than those of the control group(P<0.05).Following up for 10-22 months,15 patients in the experimental group showed progress and 5 died,while 12 patients in the control group showed progress and 4 died.There were 2 cases of electrosurgical syndrome,4 cases of postoperative bleeding and 1 case of postoperative urethral stricture in the experimental group.Conclusions PKRP combined with endocrine therapy for the treatment of advanced prostate cancer with bladder outlet obstruction has a significant short-term effect,which can significantly improve the prostate function and clinical symptoms of the patients,improve the quality of life of the patients'survival period,and has a high clinical practical value.