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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:
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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/OL]. 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/OL]. 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）
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