切换至 "中华医学电子期刊资源库"
高级检索
中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 142 -147. doi: 10.3877/cma.j.issn.1674-0785.2018.03.004

所属专题： 文献；

临床研究

经尿道双极等离子前列腺电切术或α1A受体阻滞剂联合内分泌治疗晚期前列腺癌伴膀胱出口梗阻的疗效观察
杨晓亮1,†(), 张艳斌1, 魏灿1, 王伟1, 席俊华1, 应全胜1, 吴畏1, 杨振兴1, 陈运1, 倪大伟1   
  1. 1. 230011　合肥，安徽医科大学附属合肥医院泌尿外科
  • 收稿日期:2017-07-11 出版日期:2018-02-01
  • 通信作者: 杨晓亮

Transurethral bipolar plasma prostate resection or alpha 1A receptor blocker in combination with endocrine therapy for treatment of bladder outlet obstruction in patients with advanced prostate cancer

Xiaoliang Yang1,†(), Yanbin Zhang1, Can Wei1, Wei Wang1, Junhua Xi1, Quansheng Ying1, Wei Wu1, Zhenxing Yang1, Yun Chen1, Dawei Ni1   

  1. 1. Urological Department of Affiliated Hefei Hospital of Anhui Medical University, Hefei 230011, China
  • Received:2017-07-11 Published:2018-02-01
  • Corresponding author: Xiaoliang Yang
  • About author:
    Corresponding author: Yang Xiaoliang, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

杨晓亮, 张艳斌, 魏灿, 王伟, 席俊华, 应全胜, 吴畏, 杨振兴, 陈运, 倪大伟. 经尿道双极等离子前列腺电切术或α1A受体阻滞剂联合内分泌治疗晚期前列腺癌伴膀胱出口梗阻的疗效观察[J]. 中华临床医师杂志(电子版), 2018, 12(03): 142-147.

Xiaoliang Yang, Yanbin Zhang, Can Wei, Wei Wang, Junhua Xi, Quansheng Ying, Wei Wu, Zhenxing Yang, Yun Chen, Dawei Ni. Transurethral bipolar plasma prostate resection or alpha 1A receptor blocker in combination with endocrine therapy for treatment of bladder outlet obstruction in patients with advanced prostate cancer[J]. Chinese Journal of Clinicians(Electronic Edition), 2018, 12(03): 142-147.

目的

探讨经尿道双极等离子前列腺电切术（TUPKP）联合最大限度雄激素阻断（MAB）与α1A受体阻滞剂（α1A-b）联合MAB治疗晚期前列腺癌伴膀胱出口梗阻（BOO）的临床疗效和安全性。

方法

回顾性分析2010年11月至2017年1月间安徽医科大学附属合肥医院泌尿外科收治的52例晚期前列腺癌伴BOO的病例，其中TUPKP联合MAB组29例，α1A-b联合MAB组23例。采用t检验对比2组治疗前及治疗后3个月前列腺特异性抗原（PSA）、残余尿量（PVR）、生活质量评分（QOL）、国际前列腺症状评分（IPSS）、最大尿流率（Qmax）等指标差异，随访并评估比较2组患者1、3、5年生存率及总体生存率，生存分析应用Kaplan-Meier法，组间比较采取Log-Rank检验。

结果

治疗前TUPKP联合MAB组与α1A-b联合MAB组PSA、PVR、QOL、IPSS及Qmax分别为（37.94±25.58）μg/L vs（47.29±42.10）μg/L、（158.07±57.81）ml vs（151.17±55.70）ml、（5.10±0.82）分vs（5.26±0.81）分、（26.62±3.78）分vs（25.83±4.21）分、（6.50±1.63）ml/s vs（6.60±2.26）ml/s。治疗3个月后2组PSA、PVR、QOL、IPSS及Qmax分别为（2.86±2.16）μg/L vs（5.19±3.54）μg/L、（31.17±19.97）ml vs（92.48±42.62）ml、（1.48±0.87）分vs（4.00±1.04）分、（7.83±3.26）分vs（16.57±3.87）分、（18.27±4.47）ml/s vs（9.10±2.82）ml/s。TUPKP联合MAB组与α1A-b联合MAB组治疗后较治疗前PSA、PVR、QOL、IPSS均降低，Qmax升高，且差异均具有统计学意义（t=7.688、14.013、18.582、22.737、-14.058，P均<0.001；t=4.800、9.716、6.996、8.377、-7.096，P均<0.001）。治疗3个月后，TUPKP联合MAB组与α1A-b联合MAB组比较PSA、PVR、QOL、IPSS均降低，且差异均具有统计学意义（t=2.777，P=0.009；t=6.367，P<0.001；t=9.478，P<0.001；t=8.831，P<0.001），Qmax则升高，差异无统计学意义（t=-1.762，P=0.084）。TUPKP联合MAB组与α1A-b联合MAB组中位生存时间分别为57.24个月、56.46个月，2组患者1、3、5年生存率及总体生存率比较，差异无统计学意义（χ2=0.012，P=0.915）。

结论

TUPKP联合MAB与α1A-b联合MAB治疗晚期前列腺癌合并BOO，二者都能使BOO症状获得明显缓解，使患者的生活质量得到改善，二者相比TUPKP联合MAB疗效更显著，且对患者生存率并无明确负面影响，是一种治疗晚期前列腺癌合并BOO的安全有效方法。

关键词: 前列腺癌, 膀胱出口梗阻, 经尿道双极等离子电切术, α1A受体阻滞剂, 内分泌治疗
Objective

To investigate the clinical efficacy and safety of transurethral bipolar plasma prostate resection (TUPKP) combined with maximal androgen blockade (MAB ) and alpha 1A receptor blocker (α1A-b) combined with MAB in the treatment of bladder outlet obstruction (BOO) in patients with advanced prostate cancer.

Methods

From November 2010 to January 2017, 52 advanced prostate cancer patients with BOO at the Urological Department of Affiliated Hefei Hospital of Anhui Medical University were retrospectively analyzed, including 29 patients who underwent TUPKP plus MAB and 23 patients who underwent α1A-b treatment plus MAB. The t-test was used for comparison of prostate specific antigen (PSA), postvoid residual urine volume (PVR), quality of life score (QOL), the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and other variables between the two groups before and 3 months after treatment. The 1-, 3-, and 5-year survival rates and overall survival rate were compared between the two groups. Survival analysis was performed by Kaplan-Meier method, and log-rank test was used for comparison between the groups.

Results

Before treatment, the PSA, PVR, QOL, IPSS, and Qmax in the TUPKP+ MAB and 1A-b+ MAB groups were (37.94±25.58) μg/L vs (47.29±42.10) μg/L, (158.07±57.81) mL vs (151.17±55.70) mL, (5.10±0.82) vs (5.26±0.81), (26.62±3.78) vs (25.83±4.21), and (6.50±1.63) mL/s vs (6.60±2.26) mL/s, respectively. After 3 months of treatment, the PSA, PVR, QOL, IPSS, and Qmax in the two groups were (2.86±2.16) μg/L vs (5.19±3.54) μg/L, (31.17±19.97) mL vs (92.48±42.62) mL, (1.48±0.87) vs (4.00±1.04), (7.83±3.26) vs (16.57±3.87), and (18.27±4.47) mL/s vs (6.60±2.26) mL/s, respectively. After treatment, the PSA, PVR, QOL, and IPSS in the TUPKP+ MAB and 1A-b+ MAB groups decreased significantly compared with the values before treatment, while the Qmax significantly increased, and the difference was statistically significant (t=7.688, 14.013, 18.582, 22.737, -14.058, P<0.001; t=4.800, 9.716, 6.996, 8.377, -7.096, P<0.001, respectively). After 3 months of treatment, compared with the α1A-b+ MAB group, the PSA, PVR, QOL, and IPSS in the TUPKP+ MAB group significantly decreased (t=2.777, P=0.009; t=6.367, P<0.001; t=9.478, P<0.001; t=8.831, P=0.000), while the Qmax was higher, but the difference was not statistically significant (t=-1.762, P=0.084). There was no significant difference in the 1-, 3-, or 5-year survival rate or overall survival rate between the two groups (χ2=0.012, P=0.915).

Conclusions

Both TUPKP+ MAB and α1A-b+ MAB for advanced prostate cancer patients with BOO can significantly alleviate BOO symptoms and improve the quality of life. Compared with α1A-b+ MAB, TUPKP+ MAB has more significant effect and has no definite negative effect on the survival rate of the patients. TUPKP+ MAB is a safe and effective method for the treatment of BOO in patients with advanced prostate cancer.

Key words: Prostate cancer, Bladder outlet obstruction, Bipolar transurethral plasma kinetic prostatectomy, α1A-blocker, Endocrine therapy
表1 2组前列腺癌伴膀胱出口梗阻患者基本临床资料比较
组别 例数 年龄（岁） 前列腺体积（ml） 骨转移［例（%）］ Gleason评分（分） 临床分期（例）
Ⅲ期 Ⅳ期
TUPKP＋MAB组 29 76.24±6.99 68.78±33.09 21（72.41） 6.79±0.98 5 21
α1A-b＋MAB组 23 74.22±5.33 63.22±27.97 16（69.57） 6.78±1.28 7 19
统计值 ? t=1.149 t=0.645 χ2=0.51 t=0.034 χ2=0.433
P值 ? 0.256 0.522 0.822 0.973 0.510
表2 2组前列腺癌伴膀胱出口梗阻患者治疗前后各项指标的改变（±s）
组别 PSA（μg/L） PVR（ml） QOL（分）
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
TUPKP＋MAB组 37.94±25.58 2.86±2.16 7.688 <0.001 158.07±57.81 31.17±19.97 14.013 <0.001 5.10±0.82 1.48±0.87 18.582 <0.001
α1A-b＋MAB组 47.29±42.10 5.19±3.54 4.800 <0.001 151.17±55.70 92.48±42.62 9.716 <0.001 5.26±0.81 4.00±1.04 6.996 <0.001
t值 -0.989 2.777 ? ? 0.119 6.367 ? ? 0.693 9.478 ? ?
P值 0.327 0.009 ? ? 0.906 <0.001 ? ? 0.492 <0.001 ? ?
组别 IPSS（分） Qmax（ml/s）
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
TUPKP＋MAB组 26.62±3.78 7.83±3.26 22.737 <0.001 6.50±1.63 18.27±4.47 -14.058 <0.001
α1A-b＋MAB组 25.83±4.21 16.57±3.87 8.377 <0.001 6.60±2.26 9.10±2.82 -7.096 <0.001
t值 0.716 8.831 ? ? 0.186 -1.762 ? ?
P值 0.477 <0.001 ? ? 0.853 0.084 ? ?
表3 2组前列腺癌伴膀胱出口梗阻患者1、3、5年生存率比较（%）
组别 例数 1年 3年 5年
TUPKP＋MAB组 29 89.65 72.41 62.07
α1A-b＋MAB组 23 91.30 69.57 60.87
χ2值 ? 0.040 0.051 0.008
P值 ? 0.841 0.822 0.930
图1 TUPKP联合MAB组与α1A-b联合MAB组生总体生存率比较（χ2=0.012，P=0.915）
[1]
Center MM, Jemal A, Lortet-Tieulent J, et al. International variation in prostate cancer incidence and mortality rates [J]. Eur Urol, 2012, 61(6): 1079-1092.
[2]
叶木石，李卓，颜赟坤. 内分泌治疗联合经尿道前列腺电切术对晚期前列腺癌患者预后的影响 [J]. 广东医学, 2016, 37(16): 2462-2464.
[3]
郭建勇. TURP加去势术结合内分泌治疗晚期前列腺癌疗效观察 [J]. 西部医学, 2011, 23(11): 2174-2175.
[4]
陶凌松，陶良俊，陈弋生, 等. 晚期前列腺癌伴膀胱出口梗阻TURP或α1A受体阻滞剂联合内分泌治疗的疗效分析 [J]. 中华男科学杂志, 2015, 21(7): 626-629.
[5]
王强，王军起，管同郁, 等. 合并膀胱出口梗阻的晚期前列腺癌的治疗 [J]. 中华男科学杂志, 2013, 19(2): 184-185.
[6]
马彦，刘迪，李兵, 等. 经尿道前列腺电切术治疗晚期前列腺癌伴膀胱出口梗阻的疗效观察 [J]. 临床泌尿外科杂志, 2013, 28(6): 450-452.
[7]
王刚，杨阔，孟帅, 等. 中国人前列腺癌发病关键基因的生物信息学研究 [J]. 中华男科学杂志, 2010, 16(4): 320-324.
[8]
Altay B, Erkurt B, Kiremit MC, et al. A comparison of 120 W laser photoselective vaporization versus transurethral resection of the prostate for bladder outlet obstruction by prostate cancer [J]. Urol Int, 2015, 94(3): 326-329.
[9]
Liu L, Hou XF, Ma LL, et al. Efficacy and outcome of palliative TURP in patients with bladder outlet obstruction induced by advanced prostate cancer [J]. Beijing Da Xue Xue Bao, 2015, 47(4): 597-600.
[10]
关喜彬，武良，舒则荣, 等. 经尿道前列腺等离子双极电切术安全性与有效性的系统评价[J]. 浙江创伤外科, 2015, 20(4): 641-644.
[11]
周亚，林长丰，李永, 等. 经尿道前列腺等离子双极电切治疗良性前列腺增生症 [J]. 河北医药, 2016, 38(10): 1533-1534.
[12]
Hanks GE, Leibel S, Kramer S. The dissemination of cancer by transurethral resection of locally advanced prostate cancer [J]. J Urol, 1983, 129(2): 309-311.
[13]
Austin JP, Aziz H, Potters L, et al. Effects of pretreatment transurethral resection on survival in prostatic carcinoma [J]. J Natl Med Assoc, 1994, 86(11): 833-838.
[14]
Moreno JG, O′Hara SM, Long JP, et al. Transrectal ultrasound-guided biopsy causes hematogenous dissemination of prostate cells as determined by RT-PCR [J]. Urology, 1997, 49(4): 515-520.
[15]
Krupski TL, Stukenborg GJ, Moon K, et al. The relationship of palliative transurethral resection of the prostate with disease progression in patients with prostate cancer [J]. BJU Int, 2010, 106(10): 1477-1483.
[16]
Fowler JJ, Fisher HA, Kaiser DL, et al. Relationship of pretreatment transurethral resection of the prostate to survival without distant metastases in patients treated with 125I-implantation for localized prostatic cancer [J]. Cancer, 1984, 53(9): 1857-1863.
[17]
Heung YM, Walsh K, Sriprasad S, et al. The detection of prostate cells by the reverse transcription-polymerase chain reaction in the circulation of patients undergoing transurethral resection of the prostate [J]. BJU Int, 2000, 85(1): 65-69.
[1] 方晔, 谢晓红, 罗辉. 品管圈在提高前列腺癌穿刺检出率中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 722-727.
[2] 曹建辉, 徐栋, 冯斌, 郑俊彪, 黄伟伟. 超声造影在不同前列腺特异抗原含量前列腺癌穿刺活检中的应用价值[J]. 中华医学超声杂志（电子版）, 2023, 20(03): 307-312.
[3] 王雪菲, 海琳悦, 李立方, 肖春花. Luminal A型乳腺癌的内分泌治疗与化疗[J]. 中华乳腺病杂志(电子版), 2023, 17(05): 294-300.
[4] 郭美琴, 宋伟. Ⅳ期男性乳腺癌一线内分泌解救治疗一例[J]. 中华乳腺病杂志(电子版), 2023, 17(02): 119-121.
[5] 李全喜, 唐辉军, 张健生, 杨飞. 基于MUSE-DWI与SS-DWI技术在前列腺癌图像中的对比研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 553-557.
[6] 梅津熠, 王燕, 瞿旻, 董振阳, 周增辉, 沈显琦, 李嘉伦, 高旭. 机器人前列腺癌根治术中"膀胱外中叶"的处理[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 429-433.
[7] 刘硕儒, 王功炜, 张斌, 李书豪, 胡成. 新型溶瘤病毒M1激活内质网应激致前列腺癌细胞凋亡的机制[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 388-393.
[8] 王邦郁, 陈晓鹏, 唐国军, 王佳妮. 尿液细胞外囊泡circRNA分类器对高级别前列腺癌诊断价值的初步研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 339-342.
[9] 李全喜, 唐辉军, 唐友杰, 杨飞. DISCO成像技术在前列腺增生与前列腺癌鉴别诊断中的应用价值[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 332-335.
[10] 穆靖军, 马增妮, 曹晓明. 临床局限性前列腺癌包膜外侵犯的危险因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 326-331.
[11] 南方护骨联盟前列腺癌骨转移专家组. 前列腺癌骨转移诊疗专家共识（2023版）[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 201-208.
[12] 邵浩仁, 郭佳. 铁死亡的分子机制及其在前列腺癌治疗中的研究进展[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 294-298.
[13] 刘容, 翁铭芳, 郭春雨, 邱仁慧, 方潇, 贺立民, 邓震. 机器人辅助与普通腹腔镜前列腺癌根治术对老年患者尿控功能的影响[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(02): 169-172.
[14] 倪鑫淼, 王磊, 王潇, 陈志远, 翁小东, 刘修恒. 前列腺癌患者骨保护现状及临床用药进展[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(02): 191-195.
[15] 王苏贵, 皇立媛, 姜福金, 吴自余, 张先云, 李强, 严大理. 异质性细胞核核糖蛋白A2B1在前列腺癌中的作用及其靶向中药活性成分筛选研究[J]. 中华临床医师杂志(电子版), 2023, 17(06): 731-736.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号