影像联合穿刺病理指导下靶向冷冻消融治疗局限性前列腺癌的临床应用
The clinical application of imaging-pathology fusion guided targeted cryoablation for localized prostate cancer
目的 探讨影像联合前列腺穿刺活检病理指导下靶向冷冻消融治疗局限性前列腺癌的临床价值.方法 回顾性分析2014年6月至2017年2月64例行靶向冷冻消融治疗的局限性前列腺癌患者的临床资料.年龄45 ~ 87岁,平均77.8岁.术前PSA 5.1 ~ 19.8 ng/ml,平均15.3 ng/ml.临床分期:cT1c期6例、cT2a期35例,cT2b期23例.活检Gleason评分:6分35例,3+4分8例,4+3分21例.所有患者术前均无淋巴结或远处转移,控尿均满意,11例有勃起功能.所有患者穿刺前均接受MRI或超声造影检查,根据MRI或超声造影检查与穿刺病理结果决定冷冻消融的部位和范围.结果 64例手术均顺利完成.住院时间1~3d,平均1.6d,其中22例住院1d.手术时间85~152 min,平均99.6 min.冷冻侧别左侧38例,右侧26例.冷冻针数3针28例,2针23例,1针13例.术后第1、7天的患者满意度均为100%(64/64).12例(18.8%)出院时拔除导尿管,50例(78.1%)术后7d拔除,2例(3.1%)因尿潴留保留至2周,导尿管拔除后均控尿满意.术前有勃起功能的11例患者术后1个月勃起功能均恢复.术后7例(10.9%)出现并发症,其中尿路感染(ClavienⅡ级)2例,尿潴留(Clavien Ⅰ级)2例,会阴水肿(Clavien Ⅰ级)3例,予对症处理后好转.术后第1天5例(7.8%)出现会阴部轻微疼痛,口服止痛药物后好转.术后随访时间0.5~32.2个月,中位时间11.8个月,64例患者均存活,无局部进展或转移.8例出现生化复发,其中5例予间歇性内分泌治疗,PSA未进展.结论 影像联合穿刺病理指导下靶向冷冻消融是治疗局限性前列腺癌的一项安全有效的手术方法,并发症发生率低,患者满意度高,恢复快.
更多Objective To investigate the value of imaging-pathology fusion guided targeted cryoablation for localized prostate cancer.Methods Between June 2014 and February 2017,64 patients undergoing targeted cryoablation for localized prostate cancer were retrospectively collected and analyzed.The average age was 77.8 years old,ranging 45-87 years old.The preoperative valne of PSA ranged from 5.1 to 19.8ng/ml,with mean of 15.3 ng/ml,including 6 case of cT1c,35 cases of cT2a,and 23 cases of cT2b,and 35 cases of Gleason score 6,8 cases of 3 + 4 and 21 cases of 4 + 3.All patients had good continence and 11 cases had good erectile function before operation.All the patients received MRI or contrast-enhanced ultrasonography examinations before biopsies,and the sites and range of cryoablation were determined by MRI or contrast-enhanced ultrasonography and biopsy pathological results.Results All the patients underwent the surgery successfully.The average postoperative hospital stay was 1.6 days,ranging 1 to 3 days,including 22 cases discharged within 24 h after surgery.The operative duration ranged from 85 to 152 min,with mean of 99.6 min.The satisfaction rate of the patients was 100%.Seven patients had Clavien Ⅰ or Ⅱ postoperative complications,and recovered after symptomatic treatment.The follow-up duration ranged from 0.5 to 32.2 months,with median of 11.8 months.All patients were alive without new metastasis.Eight patients developed biochemical recurrence,5 of those underwent intermittent endocrine therapy,resulting in stable PSA levels.Conclusion Imaging-pathology fusion guided targeted cryoablation was safe and effective for localized prostate cancer with the advantages of few complications,high satisfaction rate and quick recovery.
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