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目的评价超声引导下经会阴冷冻治疗激素难治性前列腺癌的安全性和近期疗效。方法超声引导下经会阴冷冻治疗激素难治性前列腺癌12例。以PSA、前列腺MRI和全身骨扫描作为评定指标,疗效评价包括完全反应(CR)、部分反应(PR)、病情稳定(SD)和病情恶化(PD)。主观反应根据骨痛、排尿异常和血尿等症状的变化评定。分析其即刻和迟发并发症。结果平均手术时间(105±34)min。均未输血。术后平均住院(6±2)d。随访6～30个月,平均18个月。CR 3例、PR 5例、SD 2例、PD 2例。本组总有效率(CR+PR)66.7%,PSA无进展生存率83.3%。主观反应均明显改善。拔除尿管后,控尿满意7例;5例尿失禁3～7 d后,恢复控尿。术后出现尿道坏死组织2例,尿道直肠瘘1例,会阴部不适1例。结论超声引导下经会阴冷冻治疗激素难治性前列腺癌安全有效,但远期疗效尚需进一步观察后明确。
Objective To evaluate the safety and short-term efficacy of ultrasound-guided cryoablation of hormone-refractory prostate cancer. Methods 12 cases of hormone refractory prostate cancer were treated by perineal cryotherapy guided by ultrasound. PSA, prostate MRI and whole body bone scan were used as evaluation indicators. The efficacy evaluation included complete response (CR), partial response (PR), stable condition (SD) and exacerbation of disease (PD). Subjective response based on changes in pain, urination and other symptoms of hematuria. Analyze its immediate and late complications. Results The average operation time (105 ± 34) min. No blood transfusion. The average postoperative hospital stay (6 ± 2) d. Follow-up 6 to 30 months, an average of 18 months. CR 3 cases, PR 5 cases, SD 2 cases, PD 2 cases. The total effective rate (CR + PR) 66.7%, PSA progression-free survival rate of 83.3%. Subjective response were significantly improved. After removal of the catheter, 7 patients were satisfied with urine control; 5 patients received urinary incontinence 3 to 7 days later to resume urine control. Postoperative urethral tissue necrosis occurred in 2 cases, 1 case of urethral rectal fistula, 1 case of perineal discomfort. Conclusion Ultrasound guided perineal cryotherapy for hormone refractory prostate cancer is safe and effective, but the long-term efficacy needs to be further observed and clear.