215例前列腺癌治疗分析

Therapeutic effect analysis of radical prostatectomy for 215 cases of prostate cancer

摘要:

目的  探讨耻骨后根治性前列腺切除，结合个体化治疗高危前列腺癌的疗效。方法  94例高危前列腺癌中70例用3个月新辅助内分泌治疗，耻骨后根治性前列腺切除时行直肠膀胱隔（Denonvillier）筋膜前脂肪垫、前列腺、双侧神经血管束整块切除，对淋巴管造影提示可疑淋巴结转移49例给予扩大淋巴清扫，其余患者按耻骨后根治性前列腺切除（Walsh）方法行耻骨后前列腺癌切除。术后对≥pT3a、Gleason分级≥8、淋巴结转移和切缘阳性者给予6个月辅助内分泌治疗或局部外放疗。比较高危与中低危前列腺癌的手术时间、术中出血量、相关并发症和3及5年生存情况。结果  耻骨后根治性前列腺切除治疗高危与中低危前列腺癌在手术时间、术中出血量、相关并发症、3年、5年总生生存率及肿瘤特异性生存率之间差异无统计学意义（P >0.05）。结论  耻骨后根治性前列腺切除，结合术后辅助内分泌治疗或局部外放疗的个体化处理，有望使部分局限性高危前列腺癌达到与中低危前列腺癌相似的治疗效果。

Abstract:

Objective To compare the therapy effect of retropubic radical prostatectomy combined with individual treatment with single surgical treatment. Methods A number of 70 from 94 high risk prostate cancer cases were administrated with 3 months neoadjuvant hormonal therapy. And then anterior Denonvillier fascia fat, bulky prostate, bilateral NBV were removed. The extended lymph nodes dissection was performed when it was suspicious of lymph nodes metastasis on lymphography. Other patients had retropubic radical prostatectomy by Walsh Method. The assisted 6 months hormonal therapy or local external beam radiotherapy were given to patients with stage ≥ pT3a, Gleason ≥ 8, lymph nodes metastasis and positive surgical margin. The operation times, blood loss in operation, complications, number and survival rate in 3 and 5 years were compared between the 2 groups. Results The operation times, blood loss in operation, complications, and the number of 3 and 5 years overall survival rate and tumor specific survival rate between the 2 groups had no significant difference (P > 0.05). Conclusions The selective local high risk prostate cancer patients could get more values from retropubic radical prostatectomy combined with post operational assisted hormonal therapy or external beam radiotherapy.