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目的探讨经尿道前列腺汽化电切(TUVRP)术联合保留附睾去势术治疗膀胱出口梗阻(BOO)的晚期前列腺癌(PCa)之疗效。方法对62例晚期PCa伴BOO患者应用保留附睾去势术联合TUVRP等综合治疗。比较分析术前及术后3个月的前列腺症状评分(IPSS)、最大尿流率(MFR)、残余尿以及血清总PSA值情况。采用问卷调查保留附睾去势患者的满意度。结果62例手术均一次成功,未发生大出血和电切综合征(TURS),无术后阴囊血肿等并发症。TUVRP平均时间(65±12)min,保留附睾、附睾成形及睾丸切除平均时间(28±9)min。患者对去势术的满意度达到(59/62)95.2%。术后随访10～38个月,平均26个月。55例获随访。癌性死亡12例,非癌性死亡8例。术后患者排尿梗阻症状明显改善,术前IPSS(25.9±1.8)分,术后3个月的IPSS(9.1±0.5)分(P<0.05);MFR术前平均(6.5±2.9)ml/s,术后3个月(13.2±4.1)ml/s(P<0.05);术前残余尿(167±41)ml,术后3个月残余尿(30±13)ml(P<0.05);术前血清总PSA值(70.3±8.5)ng/ml,术后3个月总PSA值(15.2±1.7)ng/ml(P<0.05)。术后有少数患者出现尿频和急迫性尿失禁,有2例患者随访时出现排尿梗阻症状而再次行TUVRP术。结论对晚期PCa病人伴BOO行TUVRP是安全有效的治疗手段,能迅速解除BOO症状;保留附睾去势术安全、经济且满足患者对外观形态和心理需要。
Objective To investigate the efficacy of transurethral electrovaporization of the prostate (TUVRP) combined with retention of epididymitis in the treatment of advanced prostate cancer (PCa) with bladder outlet obstruction (BOO). Methods 62 patients with advanced PCa with BOO retained epididymis castration combined with TUVRP and other comprehensive treatment. Prostate symptom score (IPSS), maximal flow rate (MFR), residual urine and total serum PSA were compared before and after 3 months. Satisfaction of patients with preserved epididymis by questionnaire. Results All the 62 surgeries were successful. There were no complications such as major bleeding and TURS and no postoperative scrotal hematoma. The mean time of TUVRP was (65 ± 12) min, with epididymis and epididymal formation preserved and the average time of orchidectomy (28 ± 9) min. Patient satisfaction with castration achieved (59/62) 95.2%. The patients were followed up for 10 to 38 months with an average of 26 months. 55 cases were followed up. 12 cases of cancerous death and 8 cases of non-cancerous death. The postoperative urinary obstruction symptoms were significantly improved in patients with preoperative IPSS (25.9 ± 1.8) and IPSS (9.1 ± 0.5) at 3 months postoperatively (P <0.05); mean preoperative MFR was (6.5 ± 2.9) ml / s , Postoperative residual urine (167 ± 41) ml and residual urine (30 ± 13) ml at 3 months postoperatively (13.2 ± 4.1) ml / s (P <0.05); The total preoperative serum PSA was (70.3 ± 8.5) ng / ml and the total PSA was 15.2 ± 1.7 ng / ml at 3 months after operation (P <0.05). A small number of patients after surgery appeared urinary frequency and urge incontinence, 2 patients were followed up urinary obstruction symptoms and TUVRP again. Conclusions TUVRP is a safe and effective treatment for patients with advanced PCa with BOO. It can quickly relieve the symptoms of BOO. Epididymal ovariectomy is safe, economical and satisfies the appearance and psychological needs of patients.