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目的探讨经会阴前列腺癌根治术在早期局限性前列腺癌治疗中的应用价值。方法总结28例临床分期T1a～T2b前列腺癌患者经会阴前列腺癌根治术临床资料。经直肠B超引导下前列腺穿刺活检,证实为前列腺腺癌,Gleason评分2～4分13例,5～7分15例。血清PSA2.3～16.6ng/ml,平均9.2ng/ml。术前CT或MRI检查确定前列腺癌局限于前列腺包膜内,胸部、脊椎与骨盆X线平片、ECT均未发现远处转移灶。临床分期T1a～b3例,T1c5例,T2a13例,T2b7例。结合血清PSA、临床分期和Gleason评分预测临床早期前列腺癌的病理分期均在T2内,28例均行经会阴前列腺癌根治术,未行盆腔淋巴结切除。结果术后保留导尿5d,拔除导尿管后,23例患者控尿良好,4例患者有3～7d短暂的尿失禁。发生尿道直肠瘘1例,术后2个月瘘道自行愈合。术后病理:肿瘤局限于前列腺包膜内27例,有单侧包膜外浸润(T3a)1例。28例术后随访6～30个月。术后3个月PSA<0.04ng/ml24例,1例<0.01ng/ml,2例未检测到PSA。1例切缘阳性(T3a)、术后PSA持续升高者,行双侧睾丸切除。术后6个月20例同时复查胸部X线片和全身骨扫描,未发现远处转移病灶。结论经会阴前列腺癌根治术治疗早期局限性前列腺癌在肿瘤控制和排尿控制方面有突出优势,结合PSA、临床分期和Gleason评分选择的病例,不需行盆腔淋巴结切除。
Objective To investigate the value of perineal radical prostatectomy in the treatment of early localized prostate cancer. Methods The clinical data of 28 patients with clinical stage T1a ~ T2b prostate cancer who underwent radical prostatectomy were summarized. Transrectal B-guided prostate biopsy, confirmed as prostate cancer, Gleason score 2 to 4 in 13 cases, 5 to 7 points in 15 cases. Serum PSA2.3 ~ 16.6ng / ml, an average of 9.2ng / ml. Preoperative CT or MRI to determine the prostate cancer confined to the prostate capsule, chest, spine and pelvis X-ray, ECT found no distant metastases. Clinical stage T1a ~ b3 cases, T1c5 cases, T2a13 cases, T2b7 cases. Combined with serum PSA, clinical stage and Gleason score predict the clinical stage of early stage of prostate cancer in T2, 28 cases underwent perineal radical prostatectomy without pelvic lymph node dissection. Results After catheterization for 5 days, urinary catheterization was performed in 23 patients. Short-term urinary incontinence occurred in 3 to 7 days in 4 patients. One case of urethral rectal fistula occurred, 2 months after the fistula self-healing. Postoperative pathology: The tumor was confined to the prostate capsule in 27 cases, with unilateral extracapsular infiltration (T3a) in 1 case. 28 cases were followed up for 6 to 30 months. There were 24 cases of PSA <0.04 ng / ml at 3 months after operation, 1 case of <0.01 ng / ml, and no PSA was detected in 2 cases. One case of positive margins (T3a), PSA continued to rise, bilateral orchidectomy. At 6 months after operation, chest X-ray and whole body bone scan were performed simultaneously in 20 cases. No distant metastasis was found. Conclusions The treatment of early localized prostate cancer by perineal radical prostatectomy has prominent advantages in tumor control and urinary control. Combined with PSA, clinical stage and Gleason score, no pelvic lymph node dissection is needed.