晚期前列腺癌膀胱出口梗阻患者姑息性经尿道前列腺切除术疗效评价

doi:10.3969/j.issn.1671-167X.2015.04.009

摘要/Abstract

摘要：

目的：评估晚期前列腺癌合并严重膀胱出口梗阻患者实施姑息性经尿道前列腺切除术（palliative transurethral resection of the prostate，pTURP）的治疗效果及预后。方法：回顾性分析北京大学第三医院泌尿外科2007年11月至2015年1月所有实施pTURP的16例晚期前列腺癌膀胱出口梗阻患者，这16例患者的肿瘤分期为Ⅲ期或Ⅳ期，均伴严重膀胱出口梗阻症状（内分泌治疗后仍有尿潴留、大量残余尿及合并上尿路积水）。收集患者临床资料、围手术期以及术后随访情况，并通过Kaplan-Meier分析计算病例的肿瘤特异生存率。结果：患者平均年龄73.8岁（63~81岁），其中前列腺癌Ⅲ期5例、Ⅳ期11例；手术指征为12例反复发生尿潴留，4例大量残余尿伴尿路积水；手术前平均前列腺体积43.2 mL（28~78 mL），术前平均前列腺特异性抗原（prostatespecific antigen，PSA）48.2 μg/L（ng/mL，2~107 μg/L），残余尿量166.4 mL（50~450 mL），术前平均尿流率为3.6 mL/s（0~6 mL/s, n=7）。手术时间62.9 min（35~94 min），出血量126.9 mL（30~263 mL），手术切除组织14.1 g （10~22 g），无输血病例。术后PSA平均20.5 μg/L（1~41 μg/L），残余尿量平均43.4 mL（0~ 400 mL），平均尿流率为10.1 mL/s（7~16 mL/s, n=7）；1例出现术后持续血尿，保守治疗后好转；术后6例患者延迟排尿，1例需长期留置膀胱造瘘管；2例患者进行二次手术切除。与术前相比，患者pTURP术后血清PSA下降（P＜0.001），残余尿量减少（P＜0.001），平均尿流率增加（P= 0.001）。平均随访时间36个月（1~86个月）， 3例患者死于前列腺癌的进展，患者pTURP术后2年、3年及5年肿瘤特异生存率分别为91%、78%、58%。结论：pTURP对缓解晚期前列腺癌患者膀胱出口梗阻有效，但组织切除量少、术后延迟排尿及二次手术率高，虽然不能完全排除手术对生存率的不良影响，但术后相对较高的肿瘤特异性生存率提示pTURP是一个可以选择的术式。

关键词: 经尿道前列腺切除术, 前列腺肿瘤, 膀胱颈梗阻

Abstract:

Objective： To evaluate the efficacy and outcome of palliative transurethral resection of the prostate (pTURP) in patients with server bladder outlet obstruction (BOO) due to prostatic obstruction induced by advanced prostate cancer.Methods:All the 16 patients who had a pTURP between November 2007 and January 2015 due to BOO (high residual urine volume combined with hydronephrosis or urinary retention refractory to medical treatment ) at our institution were retrospectively assessed. All the patients were diagnosed with advanced prostate cancer (Ⅲ stage or Ⅳ stage). The clinical data, functional and oncological follow-up results were evaluated. The cancer specific survivals were estimated by Kaplan-Meier analysis.Results:The mean age of the patients was 73.8 years (63－81 years). Five cases were graded in stage Ⅲ of prostate cancer and 11 in stage Ⅳ. The indications for pTURP were refractory urinary retention in 12 cases, and high residual urine volume with hydronephrosis in 4 cases. The mean prostate volume at pTURP was 43.2 mL (28－78 mL) and the mean PSA (prostate specific antigen) level before pTURP was 48.2 μg/L (2－107 μg/L). The patients had mean residual urine volume 166.4 mL (50－450 mL) and mean urinary flow rate 3.6 mL/s(0－6 mL/s, n=7) before pTURP. It took mean 62.9min (35－94 min) in pTURP with mean estimated blood loss 126.9 mL (30－263 mL) and mean resected tissue 14.1 g (10－22 g). There were no transfusion cases. Postoperative mean serum PSA 20.5 μg/L (1－41 μg/L), residual urine volume 43.4 mL (0－400 mL) and urinary flow rate 10.1 mL/s (7-16 mL/s, n=7) were shown in these cases. A patient encountered persistent hematuria needing irrigation. Compared with preoperation, the patients had significantly lower serum PSA level (P<0.001), less residual urine volume (P<0.001) and more urinary flow rate (P=0.001) after pTURP. The mean follow-up after pTURP was 36 months (1－86 months). In addition, 2 patients received repeated pTURP. At the time of the latest analysis, 3 patients died from prostate cancer progression. As estimated by KaplanMeier analysis, the 2-, 3- and 5-year cancer specific survival rates after pTURP were 91%, 78% and 58%, respectively.Conclusion:Despite less resected tissue, greater delay in urination and reoperation rates, pTURP is a fairly effective procedure in patients with server BOO . Although a potential negative impact of pTURP on survival cannot be excluded, the estimated 3 and 5year cancer specific survival rates in this series seem to justify this intervention.

Key words: Prostatic neoplasms, Urinary bladder neck obstruction, Transurethral resection of prostate

中图分类号:

R737.25

刘磊, 侯小飞, 马潞林, 赵磊, 张洪宪. 晚期前列腺癌膀胱出口梗阻患者姑息性经尿道前列腺切除术疗效评价[J]. 北京大学学报(医学版), 2015, 47(4): 597-600.

LIU Lei, HOU Xiao-Fei, MA Lu-Lin, ZHAO Lei, ZHANG Hong-Xian. Efficacy and outcome of palliative TURP in patients with bladder outlet obstruction induced by advanced prostate cancer[J]. Journal of Peking University(Health Sciences), 2015, 47(4): 597-600.

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