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目的评价MR成像引导下激光治疗临床低风险前列腺癌的MR成像表现与其活检结果相一致的可行性及安全性。材料与方法本项前瞻性Ⅰ期研究获得机构审查委员会批准,符合HIPAA标准,免除知情同意书。对Gleason评分≤7分、经直肠超声(US)引导的六分度活检阳性率≤3针且与MR成像表现相一致的临床低风险前列腺癌病人行经会阴MR引导局灶性激光消融治疗。通过激光消融系统对病灶定位。记录围手术期并发症。在治疗前后分别记录国际前列腺症状评分(IPSS)和男性性健康目录评分(SHIM)。治疗6个月后对消融区行MR引导下穿刺活检。采用秩和检验比较消融前后前列腺特异性抗原水平、IPSS及SHIM评分。结果 9例病人成功完成消融治疗(手术时间为2.5~4h;平均激光消融持续时间为4.3min)。治疗后立即行增强MRI检查,8例病人表现为乏血供性信号缺损。1例病人会阴区磨损和龟头阴茎感觉异常自行消失。IPSS和SHIM评分的基线均值(±标准差)分别为5.8±5.3和19.0±8.0。随访期间平均分数变化与基线值的差异无统计学意义(P=0.18~0.99)。消融区MR引导下穿刺活检显示7例(78%)病人未见癌细胞,2例(22%)为Gleason 6级的恶性肿瘤。结论对于临床低风险前列腺癌,经会阴MR引导下局灶激光消融术是一种安全可行的局灶治疗选择。
OBJECTIVE: To evaluate the feasibility and safety of MR imaging-guided laser in the treatment of clinical low-risk prostate cancer with MR imaging and biopsy results. Materials and Methods This prospective phase I study was approved by the Institutional Review Board and conforms to the HIPAA standard and is exempt from informed consent. For patients with clinically low-risk prostate cancer who had a Gleason score of ≤7, sex-negative biopsy-positive rates of ≤3 and guided by transrectal ultrasound (US), consistent with MR imaging, guided perineal MR-guided focal laser ablation. Locate the lesion through a laser ablation system. Perioperative complications were recorded. International Prostate Symptom Score (IPSS) and Male Sexual Health Inventory Score (SHIM) were recorded before and after treatment. After 6 months of treatment, MR guided biopsy was performed in the ablation zone. Rank-sum test was used to compare the levels of prostate-specific antigen, IPSS and SHIM before and after ablation. Results Nine patients successfully completed ablation (operation time was 2.5 ~ 4h; average duration of laser ablation was 4.3min). Immediately after treatment, an enhanced MRI examination was performed, and 8 patients showed deficiency of donor signal deficiency. 1 patient perineal wear and glans penis sensory abnormalities disappear. The baseline mean ± standard deviation (IPSS) and SHIM scores were 5.8 ± 5.3 and 19.0 ± 8.0, respectively. There was no significant difference in mean scores during follow-up between baseline and baseline (P = 0.18-0.99). Puncture biopsy under MR guidance in the ablation zone showed no cancer cells in 7 patients (78%), and Gleason grade 6 malignancies in 2 patients (22%). Conclusions For clinical low-risk prostate cancer, focal laser ablation is a safe and feasible focal treatment under the guidance of perineal MR.