前列腺动脉栓塞联合腹腔镜前列腺癌根治术治疗大体积前列腺癌的研究
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摘要
目的探讨前列腺动脉栓塞联合腹腔镜前列腺癌根治术治疗大体积前列腺癌(>80 g)的临床意义。方法金华市中心医院自2014年1月—2018年10月收治32例大体积前列腺癌患者。前列腺穿刺后2个月直接行腹腔镜前列腺癌根治术16例(A组),其中T2b期10例,T2c期6例,年龄65～79岁,中位年龄73岁。前列腺穿刺后先行前列腺动脉栓塞术,2个月后再行腹腔镜前列腺癌根治术16例(B组),其中T2b期9例,T2c期7例,年龄67～80岁,中位年龄72岁。比较2组患者的手术时间、术中出血量、术后留置导尿时间、术后住院时间及术后并发症等指标。结果 32例患者均顺利完成手术,但大体积前列腺癌行腹腔镜前列腺癌根治术难度较大。B组患者前列腺动脉栓塞术后2个月复查前列腺缩小51.09%～38.45%。B组患者的手术时间、术中出血量、术后留置导尿时间、术后住院时间、术后并发症均明显低于A组,差异均有统计学意义(P<0.05)。32例患者在术后2个月复查血PSA均<0.01 ng/mL。结论前列腺动脉栓塞2个月后行腹腔镜前列腺癌根治术,尝试一种从根本上解决大体积前列腺癌手术困难的方法,降低手术难度,减少术中及术后并发症。
Objective To investigate the clinical significance of prostatic arterial embolization(PAE) combined with laparoscopic radical prostatectomy for prostate cancer patients with large prostate glands(>80 g). Methods Sixteen prostate cancer patients with large prostate glands were treated during January 2014 to October 2018 in Jinhua Municipal Center Hospital. Sixteen cases(group A) which received laparoscopic radical prostatectomy 2 months after prostate biopsy by using B ultrasound guidance. In group A, there were 10 cases of T2 b, 6 cases of T2 c, aged from 65 to 79 years. Sixteen cases(group B) diagnosed with prostate cancer which received laparoscopic radical prostatectomy 2 months after prostatic arterial embolization. In group B, there were 9 cases of T2 b, 7 cases of T2 c, aged from 67 to 80 years. Operating time, amount of bleeding during operation, postoperative indwelling catheterization time, the hospital stay and complications were compared between group A and group B. Results All the 32 cases were operated successfully. Laparoscopic radical prostatectomy in large prostate glands poses a significant challenge to urologists. Two months after PAE, prostate volume decreased for 51.09%-38.45% in group B. In group B, operating time, amount of bleeding during operation, postoperative indwelling catheterization time, the hospital stay and complications were all better than those in group A(P<0.05). Moreover, the results of PSA of all 32 patients decreased to <0.01 ng/mL at postoperative two months. Conclusion For prostate cancer patients with large prostate glands which received laparoscopic radical prostatectomy 2 months after prostatic arterial embolization, it can reduce the difficulty of operation and reduce complications.
Objective To investigate the clinical significance of prostatic arterial embolization(PAE) combined with laparoscopic radical prostatectomy for prostate cancer patients with large prostate glands(>80 g). Methods Sixteen prostate cancer patients with large prostate glands were treated during January 2014 to October 2018 in Jinhua Municipal Center Hospital. Sixteen cases(group A) which received laparoscopic radical prostatectomy 2 months after prostate biopsy by using B ultrasound guidance. In group A, there were 10 cases of T2 b, 6 cases of T2 c, aged from 65 to 79 years. Sixteen cases(group B) diagnosed with prostate cancer which received laparoscopic radical prostatectomy 2 months after prostatic arterial embolization. In group B, there were 9 cases of T2 b, 7 cases of T2 c, aged from 67 to 80 years. Operating time, amount of bleeding during operation, postoperative indwelling catheterization time, the hospital stay and complications were compared between group A and group B. Results All the 32 cases were operated successfully. Laparoscopic radical prostatectomy in large prostate glands poses a significant challenge to urologists. Two months after PAE, prostate volume decreased for 51.09%-38.45% in group B. In group B, operating time, amount of bleeding during operation, postoperative indwelling catheterization time, the hospital stay and complications were all better than those in group A(P<0.05). Moreover, the results of PSA of all 32 patients decreased to <0.01 ng/mL at postoperative two months. Conclusion For prostate cancer patients with large prostate glands which received laparoscopic radical prostatectomy 2 months after prostatic arterial embolization, it can reduce the difficulty of operation and reduce complications.
引文
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[7] 范敏.经腹腔入路腹腔镜前列腺癌根治术(TLRP)与经腹膜外入路腹腔镜前列腺癌根治术(ELRP)治疗局限性前列腺癌的疗效和安全性研究[J].吉林医学,2017,38(10):1904-1906.
[8] 叶淦,周学鲁.动脉栓塞治疗良性前列腺增生的研究进展[J].中华介入放射学电子杂志,2017,5(1):34-38.
[9] PISCO JM,RIO TINTO H,CAMPOS PINHEIRO L,et al.Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS)secondary to benign hyperplasia:results of short-and mid-term follow-up[J].Eur Radiol,2013,23(9):2561-2572.
[10] 催林红.动脉栓塞治疗前列腺增生患者临床观察[J].世界最新医学信息文摘,2015,15(A5):53-54.
[11] 李辉明,魏世平,潘铁军,等.联合髂内动脉超选择栓塞化疗和内分泌治疗方案在晚期前列腺癌的临床应用分析[J].临床外科杂志,2014,22(7):532-533.
[12] 杨鲲,陈向东,丁满棠,等.增生前列腺及前列腺动脉栓塞后的血供变化与临床意义[J].医学临床研究杂志,2014,31(12):2305-2307.
[13] 朱伟,方主亭,朱庆国,等.超选择性前列腺动脉栓塞术治疗高危良性前列腺增生48例报告[J].中华泌尿外科杂志,2015,36(12):949-951.
[14] WANG M,GUO L,DUAN F,et al.Prostatic arterial embolization for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasis:a comparative study of medium-and largevolume prostates[J].Bju International,2016,117:155-164.
[15] 张国栋,段峰,袁凯,等.前列腺动脉栓塞术治疗良性前列腺增生症的前景与挑战[J].介入放射学杂志,2014,23(8):735-738.
[16] 吕磊,黄韬,高晓玲,等.超选择性前列腺动脉栓塞联合经尿道前列腺切除治疗重度前列腺增生的疗效[J].中华泌尿外科杂志,2018,39(9):675-678.
[2] 郭巍,强亚勇,贺晓龙,等.姜黄素联合顺铂对人前列腺癌PC-3细胞株的影响[J].中国临床保健杂志,2017,20(2):181-184.
[3] 赵静,杨晓,杨先悦,等.穿刺点选择和前列腺特异性抗原水平在前列腺癌诊断中的价值[J].中国临床保健杂志,2015,18(5):534-535.
[4] 那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南2014版[M].北京:人民卫生出版社,2014:69.
[5] 武鹏,秦卫军,张龙龙,等.机器人辅助前列腺癌根治术治疗大体积前列腺癌的临床应用研究[J].现代肿瘤医学,2018,26(3):409-412.
[6] 王海峰,杨波,高旭,等.机器人前列腺癌根治术治疗大体积前列腺癌的难点与技巧分析[J].临床泌尿外科杂志,2014,29(4):281-283,286.
[7] 范敏.经腹腔入路腹腔镜前列腺癌根治术(TLRP)与经腹膜外入路腹腔镜前列腺癌根治术(ELRP)治疗局限性前列腺癌的疗效和安全性研究[J].吉林医学,2017,38(10):1904-1906.
[8] 叶淦,周学鲁.动脉栓塞治疗良性前列腺增生的研究进展[J].中华介入放射学电子杂志,2017,5(1):34-38.
[9] PISCO JM,RIO TINTO H,CAMPOS PINHEIRO L,et al.Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS)secondary to benign hyperplasia:results of short-and mid-term follow-up[J].Eur Radiol,2013,23(9):2561-2572.
[10] 催林红.动脉栓塞治疗前列腺增生患者临床观察[J].世界最新医学信息文摘,2015,15(A5):53-54.
[11] 李辉明,魏世平,潘铁军,等.联合髂内动脉超选择栓塞化疗和内分泌治疗方案在晚期前列腺癌的临床应用分析[J].临床外科杂志,2014,22(7):532-533.
[12] 杨鲲,陈向东,丁满棠,等.增生前列腺及前列腺动脉栓塞后的血供变化与临床意义[J].医学临床研究杂志,2014,31(12):2305-2307.
[13] 朱伟,方主亭,朱庆国,等.超选择性前列腺动脉栓塞术治疗高危良性前列腺增生48例报告[J].中华泌尿外科杂志,2015,36(12):949-951.
[14] WANG M,GUO L,DUAN F,et al.Prostatic arterial embolization for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasis:a comparative study of medium-and largevolume prostates[J].Bju International,2016,117:155-164.
[15] 张国栋,段峰,袁凯,等.前列腺动脉栓塞术治疗良性前列腺增生症的前景与挑战[J].介入放射学杂志,2014,23(8):735-738.
[16] 吕磊,黄韬,高晓玲,等.超选择性前列腺动脉栓塞联合经尿道前列腺切除治疗重度前列腺增生的疗效[J].中华泌尿外科杂志,2018,39(9):675-678.
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