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目的:比较经尿道前列腺电切术(TURP)联合内分泌治疗与α1A受体阻滞剂联合内分泌治疗晚期前列腺癌伴膀胱出口梗阻的疗效,并探讨TURP联合内分泌治疗晚期前列腺癌伴膀胱出口梗阻的安全性。方法:回顾性分析2009年1月至2013年1月采用α1A受体阻滞剂联合内分泌治疗或TURP联合内分泌治疗晚期前列腺癌伴膀胱出口梗阻患者63例,其中28例行α1A受体阻滞剂联合内分泌治疗,35例行TURP联合内分泌治疗。比较两组患者治疗前后的残余尿量(RV)、最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、生活质量评分(Qo L)及总体生存率。结果:TURP联合内分泌治疗组术后3个月RV、IPSS、Qo L分别由术前的(137.8±27.6)ml、(22.3±3.6)分、(4.2±0.8)分降至(29.0±13.6)ml、(7.8±2.1)分、(1.6±0.5)分(P均<0.05),Qmax由术前的(5.6±2.1)ml/s增至(17.6±2.7)ml/s(P<0.05)。α1A受体阻滞剂联合内分泌治疗组术后3个月RV、IPSS、Qo L分别由术前的(133.6±24.9)ml、(21.5±3.2)分、(4.7±1.1)分降至(42.0±18.3)ml、(12.8±2.6)分、(2.5±0.7)分(P均<0.05),Qmax由术前的(6.3±2.4)ml/s增至(11.7±2.3)ml/s(P<0.05)。治疗3个月后两组相比,RV、IPSS、Qo L及Qmax之间的差异均具有统计学意义(P均<0.05)。α1A受体阻滞剂联合内分泌治疗组总体生存率为46.4%,TURP联合内分泌治疗组为51.4%,差异无显著性(P>0.05)。结论:较α1A受体阻滞剂联合内分泌治疗,TURP联合内分泌治疗能显著缓解晚期前列腺癌患者膀胱出口梗阻症状,且不影响总体生存率,是治疗晚期前列腺癌伴膀胱出口梗阻的首选方法。
Objective: To compare the efficacy of transurethral resection of the prostate (TURP) combined with endocrine therapy and α1A receptor blocker combined with endocrine in the treatment of advanced prostate cancer with vesical outlet obstruction and to discuss the safety of TURP combined with endocrine in the treatment of advanced prostate cancer with vesical outlet obstruction Sex. Methods: From January 2009 to January 2013, 63 patients with advanced prostate cancer with vesical outlet obstruction were treated with α1A receptor blocker combined with endocrine therapy or TURP combined with endocrine. Among them, 28 patients received α1A receptor blocker Combined endocrine therapy, 35 patients underwent TURP combined with endocrine therapy. Residual urine volume (RV), maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), quality of life score (QoL) and overall survival were compared between the two groups before and after treatment. Results: The RV, IPSS and QoL in the TURP combined with endocrine therapy group decreased from (137.8 ± 27.6) ml, (22.3 ± 3.6) and (4.2 ± 0.8) to (29.0 ± 13.6) (P <0.05), Qmax increased from (5.6 ± 2.1) ml / s to (17.6 ± 2.7) ml / s preoperatively (P <0.05) . The levels of RV, IPSS and QoL at 3 months after operation in the group of α1A receptor antagonist and endocrine therapy decreased from (133.6 ± 24.9) ml, (21.5 ± 3.2) and (4.7 ± 1.1) to 42.0 (P <0.05), Qmax increased from preoperative (6.3 ± 2.4) ml / s to (11.7 ± 2.3) ml / s (P <0.05). The differences of RV, IPSS, Qo L and Qmax between the two groups after 3 months of treatment were statistically significant (all P <0.05). The overall survival rate was 46.4% in the combination of α1A receptor blocker and endocrine therapy group, and 51.4% in the TURP combined with endocrine therapy group, with no significant difference (P> 0.05). Conclusion: Compared with α1A receptor blocker and endocrine therapy, TURP combined with endocrine therapy can significantly relieve the symptoms of bladder outlet obstruction in patients with advanced prostate cancer and does not affect the overall survival rate. It is the first choice for the treatment of advanced prostate cancer with bladder outlet obstruction.