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目的探讨姑息性TURP对前列腺癌预后的影响。方法回顾1999年1月～2008年6月TURP治疗前列腺癌BOO的临床资料,根据术后PSA不同效应,将病例分为PAS下降组和上升组,并作多参数比较。结果18例前列腺癌共计做TURP 23次,其再手术率为21%。TURP时患者平均年龄为77.8岁(67～89岁),平均TURP距ADT开始时间为(31.1±34.5)月,术前PAS值为(65.89±57.77)ng/ml,B超测得前列腺大小为(69.3±68.3)g,TURP平均操作时间为(47.4±19.2)min,切除前列腺组织重量为(22.3±17.0)g,TURP后平均随访(20.7±12.2)月,17例(94.4%)术后可自行排尿,1例(5.6%)仍需耻骨上膀胱造瘘。患者感到排尿症状显著改善者10例(55.6%),短期(<3月)改善后又加重症状者4例(22.2%),症状未改善者4例(22.2%)。TURP后1月PSA值下降者10例(55.6%),下降达(36.64±40.14)ng/ml,并维持(19±14.5)月(PSA下降组);8例(44.4%)或手术前后PSA相同(2例手术前后均为150 ng/ml)或PSA上升(6例比术前PSA上升达[(34.43±24.85)ng/ml]。在2组之间,TURP距ADT开始时间(P>0.2)、术前PSA值(P>0.2)、前列腺大小(P>0.1)、TURP操作时间(P>0.5)、被切除前列腺组织重量(P>0.5)均未达到统计学的差异。但PAS上升组证实有远处转移的T4期前列腺癌(75%)(转移达睾丸、盆腔淋巴结、多处骨骼),再手术率高(37.5%),前列腺癌特定死亡率高(75%)。结论TURP解除前列腺癌BOO是一种局部的姑息性减瘤手术,在较低分期患者中,既可以解除BOO,也可以协同ADT降低PSA,有利预后。但是,在较高分期有远处转移灶的患者中,由于癌细胞增殖增快,TURP只能短期改善排尿症状,甚至使PSA升高,不利预后,可以选择其它方法解除梗阻性排尿症状。
Objective To investigate the effect of palliative TURP on the prognosis of prostate cancer. Methods The clinical data of TURP for the treatment of prostate cancer BOO between January 1999 and June 2008 were retrospectively analyzed. According to the different effects of postoperative PSA, the patients were divided into the PAS descending group and the ascending group, and the parameters of multiple parameters were compared. Results 18 cases of prostate cancer total TURP 23 times, the reoperation rate was 21%. The mean age at TURP was 77.8 years (67-89 years). The average TURP was (31.1 ± 34.5) months from ADT and preoperative PAS was (65.89 ± 57.77) ng / ml. The size of prostate was (69.3 ± 68.3) g, the average TURP operation time was (47.4 ± 19.2) min, the weight of resected prostate tissue was (22.3 ± 17.0) g, the average follow-up time was 20.7 ± 12.2 months after TURP and 17 cases (94.4% Urination can be self, 1 case (5.6%) still need suprapubic cystostomy. Ten patients (55.6%) were found to have significantly improved urination symptoms. Four patients (22.2%) improved in short term (<3 months) and aggravated symptoms (22.2%). Four patients (22.2%) had no symptoms improvement. In the first month of TURP, the PSA value decreased in 10 patients (55.6%), and the decrease was (36.64 ± 40.14) ng / ml and remained at 19 ± 14.5 months (PSA decreased group) (Both of them were 150 ng / ml before or after surgery) or PSA increased (6 cases compared with the preoperative PSA ([34.43 ± 24.85] ng / ml] .Turple TURP from the beginning of ADT (P> 0.2), preoperative PSA (P> 0.2), prostate size (P> 0.1), TURP operation time (P> 0.5) and resected prostate tissue weight (P> 0.5) Patients in the ascending group demonstrated distant metastasis of stage T4 prostate cancer (75%) (up to the testis, pelvic lymph nodes, multiple bones), high reoperation rates (37.5%), and high prostate specific mortality rates (75%). TURP to lift prostate cancer BOO is a local palliative surgery in patients with lower stool, both can lift the BOO can also be associated with ADT to reduce PSA, favorable prognosis.However, in the higher staging of distant metastases Patients, due to rapid proliferation of cancer cells, TURP can only short-term improvement in urination symptoms, and even increased PSA, adverse prognosis, you can choose other methods to relieve obstructive urination symptoms.