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目的:探讨诊断性前列腺电切(TURP)在前列腺增生合并血清PSA异常患者中的应用价值及意义,为临床处理前列腺增生合并血清PSA异常的患者提供一种新的手段。方法:收集符合入组标准的患者71例,总结病理为前列腺癌患者的Gleason评分及预后。对所有患者进行术后随访,检测其TURP术后6个月、1年的PSA值及IPSS评分,分析术后血清PSA值、IPSS的变化,评估TURP在前列腺增生伴血清PSA异常患者中的诊疗效果。结果:①40例前列腺穿刺活检阴性而血清PSA持续异常的患者中,2例术后病理示前列腺腺癌(2/40),Gleason评分为6分,另1例电切后病理示前列腺增生组织,但术后血清PSA持续异常(18μg/L),行2次活检,病理诊断为前列腺癌,Gleason评分6分,3例均行前列腺根治性切除术,术后随访恢复好。31例拒绝活检患者中术后病理示前列腺腺癌9例(9/31)。Gleason评分7~9分,平均8分,1例行前列腺根治性切除术,8例行内分泌治疗。②59例病理诊断为良性前列腺增生(BPH),其中血清PSA恢复正常者56例,显著降低者3例,IPSS评分有明显改善53例,6例尿道狭窄经过尿扩处理后评分亦有改善。结论:诊断性TURP可提高前列腺癌的早期检出率,改善患者的下尿路症状,且有利于患者血清PSA持续正常化。对血清PSA异常(>4μg/L),伴有下尿路梗阻状态、前列腺穿刺活检阴性的患者可考虑行诊断性TURP。
Objective: To investigate the value and significance of diagnostic prostatectomy (TURP) in patients with benign prostatic hyperplasia complicated with serum PSA and to provide a new method for clinical treatment of benign prostatic hyperplasia patients with abnormal serum PSA. Methods: A total of 71 eligible patients were enrolled in this study. The Gleason score and prognosis of patients with pathological prostate cancer were summarized. All patients were followed up for 6 months and 1 year after TURP. The PSA value and IPSS score were analyzed. The postoperative serum PSA and IPSS were analyzed. The diagnosis and treatment of TURP in BPH patients with abnormal serum PSA effect. Results: Among the 40 patients with negative PSA and persistent abnormality of serum PSA, 2 patients had prostate adenocarcinoma (2/40) with Gleason score of 6, and the other 1 patient with benign prostatic hyperplasia However, postoperative serum PSA was abnormal (18μg / L). Two biopsies were performed. The pathological diagnosis was prostate cancer. The Gleason score was 6 points. Three patients underwent radical prostatectomy, and the postoperative follow-up was good. Nineteen patients (9/31) had postoperative pathologic findings of prostate adenocarcinoma in 31 patients who refused biopsy. Gleason score 7 to 9 points, an average of 8 points, 1 case of radical prostatectomy, 8 cases of endocrine therapy. ② The pathological diagnosis of benign prostatic hyperplasia (BPH) was performed in 59 cases. Among them, 56 cases were diagnosed as normal serum PSA, 3 cases were significantly decreased, IPSS score was significantly improved in 53 cases, and 6 cases urethral stricture were also improved after urinary expansion. Conclusion: Diagnostic TURP can improve the early detection rate of prostate cancer, improve the symptoms of lower urinary tract, and is beneficial to the continuous normalization of serum PSA. Diagnostic TURP may be considered in patients with abnormal serum PSA (> 4 μg / L), with lower urinary tract obstruction, and negative prostate biopsy.