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目的探讨耻骨后根治性前列腺切除(RRP)或结合内分泌、局部外放疗治疗94例高危前列腺癌的疗效。方法符合D’Amico和中国泌尿外科诊断治疗指南的高危前列腺癌定义者94例,其中70例T_(3a)~T_(3b)患者术前用3个月新辅助内分泌治疗,RRP同时行Denonvillier筋膜前脂肪垫、前列腺、双侧神经血管束整块切除,对其中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45例行标准淋巴结清扫。术后对≥pT_(3a)、Gleason评分≥8、淋巴结转移和切缘阳性者给予6 M辅助内分泌治疗或加局部外放疗。术后平均随访(66.22±40.00)月,统计手术时间、术中出血量、相关并发症、生化复发例数、生化复发时间和5年生存情况。结果 70例高危前列腺癌诊断时PSA平均为(46.45±36.45)ng/mL,新辅助内分泌治疗3个月后PSA平均为(1.02±1.15)ng/mL(P<0.01),平均手术时间(178.30±29.67)min,平均术中出血量(539.90±351.46)mL,术后证实术前19例cT_(3a)降为PT2c,吻合口漏2例,继续保留导尿3~4周愈合,淋巴漏2例,经持续引流3~4周痊愈,尿失禁6例,吻合口狭窄1例,生化复发35例,5年总生存率和肿瘤特异性生存率分别为94.2%和96.2%。结论 RRP或结合术后辅助内分泌治疗或加局部外放疗的个体化处理高危前列腺癌是一种安全可行、疗效满意的方法,有望使更多高危前列腺癌从中受益。
Objective To investigate the efficacy of radical retropubic prostatectomy (RRP) or combined with endocrine and local external radiotherapy in the treatment of 94 high-risk prostate cancers. Methods Ninety-four patients with high-risk prostate cancer were enrolled according to D’Amico and Chinese guidelines for diagnosis and treatment of urology. Totally 70 patients with T_ (3a) ~ T_ (3b) were treated with neoadjuvant endocrine therapy for 3 months. Membrane fat pad, prostate, bilateral neurovascular bundle block resection, in which lymphangiography prompted suspicious lymph node metastases were given extended lymph dissection, and the remaining 45 cases of standard lymph node dissection. After surgery for ≥ pT_ (3a), Gleason score ≥ 8, lymph node metastasis and positive margins were given 6 M adjuvant endocrine therapy or plus external radiotherapy. The patients were followed up for an average of (66.22 ± 40.00) months. The operation time, intraoperative blood loss, related complications, the number of biochemical recurrence, the biochemical recurrence time and the 5-year survival were recorded. Results The average PSA of 70 cases of high risk prostate cancer was (46.45 ± 36.45) ng / mL at 3 months after neoadjuvant endocrine therapy and (1.02 ± 1.15) ng / mL on average (P <0.01). The mean operative time (178.30 ± 29.67) min, the average blood loss (539.90 ± 351.46) mL, postoperative confirmed 19 cases of cT_ (3a) reduced PT2c, anastomotic leakage in 2 cases, to keep catheterization 3 to 4 weeks healing, 2 cases were cured by continuous drainage for 3 to 4 weeks, urinary incontinence in 6 cases, anastomotic stenosis in 1 case and biochemical recurrence in 35 cases. The 5-year overall survival rate and tumor-specific survival rate were 94.2% and 96.2% respectively. Conclusion The combination of RRP and postoperative adjuvant endocrine therapy or local external beam radiotherapy for the treatment of high-risk prostate cancer is a safe and feasible method with satisfactory curative effect, which is expected to benefit more high-risk prostate cancer.