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目的探讨隧道式经尿道前列腺切除术(TURP)治疗伴膀胱出口梗阻(BOO)的晚期前列腺癌的临床疗效及手术时机的选择。方法回顾分析2002年7月至2008年8月收治的伴BOO症状的晚期前列腺癌患者58例,年龄63～87岁,平均74岁。均经影像学和前列腺穿刺活检等系列检查明确诊断为(T3～T4)前列腺癌,对21例采用一期隧道式TURP和双侧睾丸切除术,术后行内分泌治疗;对经睾丸切除和抗雄激素联合治疗3个月的37例中仍有排尿困难的14例采用隧道式TURP治疗。结果35例患者隧道式TURP手术均成功,手术时间(65±25)min,切除前列腺平均重量42g。随访2～5年,死亡14例,其中死于前列腺癌10例,平均生存38个月,死于其他原因4例。患者术后排尿困难症状明显改善。37例患者采用内分泌治疗3个月,23例患者最终能自行排尿。结论隧道式TURP是治疗伴BOO的晚期前列腺癌的安全、简便易行、有效方法之一,虽不能改变患者的临床结局,但可迅速缓解梗阻症状,明显提高患者生活质量。对部分患者依病情可先行内分泌治疗,根据治疗效果再决定是否采用TURP处理。
Objective To investigate the clinical efficacy and timing of TURP in the treatment of advanced prostate cancer with vesical outlet obstruction (BOO). Methods A retrospective analysis of 58 patients with advanced prostate cancer with BOO symptoms from July 2002 to August 2008 were aged from 63 to 87 years with an average of 74 years. All cases were diagnosed as (T3 ~ T4) prostate cancer by series of imaging and prostatic biopsy. One-stage tunnel-type TURP and bilateral orchiectomy were performed in 21 cases. Endocrine therapy was performed after operation. Forty-seven patients with dysuria who were treated with androgen for 3 months were treated with tunnel TURP. Results Thirty-five patients underwent tunnel-type TURP successfully. The operation time was 65 ± 25 min and the mean prostate removal weight was 42 g. Follow-up 2 to 5 years, 14 patients died, of which 10 died of prostate cancer, the average survival of 38 months, died of other causes in 4 cases. Patients with dysuria symptoms improved significantly. Thirty-seven patients received endocrine therapy for 3 months, and 23 patients eventually managed to urinate on their own. Conclusions Tunnel-type TURP is one of the safe, simple and effective methods for the treatment of advanced prostate cancer with BOO. Although it can not change the clinical outcome of patients, it can relieve the symptoms of obstruction and improve the quality of life of patients. According to the condition of some patients may be the first endocrine therapy, and then decide whether to use TURP treatment according to the treatment effect.