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目的探讨125I前列腺放射粒子植入术治疗前列腺癌的效果和并发症。方法前列腺癌患者72例,临床分期T2bN0M0至T3aN0M0期63例,T3N0M19例。采用超声引导下125I前列腺放射粒子植入术治疗。术后进行雄激素全阻断辅助治疗。观察术后并发症和临床疗效。结果手术时间1~2 h,4~6 d拔除尿管出院。术后随访6~53个月,平均17个月。CR 52例,PR 12例,SD 6例,PD2例。本组病例PSA无进展生存率为97.2%(70/72)。Ⅰ级排尿症状47例,Ⅱ级排尿症状25例,无Ⅲ级和Ⅳ级排尿症状发生。伴有直肠刺激症状21例,多为轻度。术后严重出血性直肠炎1例,尿道直肠瘘1例,为同一患者,行结肠造口术和膀胱造瘘术。死亡1例。结论125I前列腺放射粒子植入术治疗前列腺癌疗效肯定、创伤小,尤其适合于不能耐受前列腺癌根治术的高龄前列腺癌患者。副作用主要为尿路和直肠症状,多为轻度和自限性的。
Objective To investigate the efficacy and complications of 125I prostate radioactive seed implantation in the treatment of prostate cancer. Methods 72 patients with prostate cancer, clinical stage T2bN0M0 to T3aN0M0 63 cases, T3N0M19 cases. Ultrasound guided 125I prostate radioactive seed implantation. Postoperative androgen blockade adjuvant therapy. Postoperative complications and clinical efficacy were observed. Results The operation time was 1 ~ 2 h, and the catheter was removed from the hospital within 4 ~ 6 d. The patients were followed up for 6 ~ 53 months with an average of 17 months. CR 52 cases, PR 12 cases, SD 6 cases, PD 2 cases. The progression-free survival rate of PSA in this group was 97.2% (70/72). Grade Ⅰ urination symptoms in 47 cases, grade Ⅱ urination symptoms in 25 cases, no grade Ⅲ and Ⅳ voiding symptoms. Symptoms associated with rectal irritation in 21 cases, mostly mild. Postoperative severe hemorrhagic proctitis in 1 case, urethral rectal fistula in 1 case, the same patient, colostomy and cystostomy. 1 case of death. Conclusion 125I prostate radioactive seed implantation in the treatment of prostate cancer has certain curative effect and less trauma. It is especially suitable for advanced prostate cancer patients who can not tolerate radical prostatectomy. Side effects are mainly urinary tract and rectal symptoms, mostly mild and self-limiting.