摘要目的 总结经尿道KTP激光前列腺汽化术(PVP)治疗伴有下尿路梗阻晚期前列腺癌的临床疗效.方法 伴有下尿路梗阻的晚期前列腺癌患者33例.年龄(76±6)岁.其中T3 18例,T4 15例.前列腺体积36～140 ml.患者术前IPSS为28.2±3.6,QOL为5.0±0.7,Q_(max) 4.7～10.1 ml/s,残余尿量(RU)为(126.0±25.2)ml.33例均行KTP激光经尿道汽化前列腺治疗.19例初发前列腺癌患者同时行PVP和睾丸切除,14例为睾丸切除和抗雄激素等治疗后仍有明显的排尿梗阻症状,有尿潴留史15例.分别对术前及PVP术后1、6个月患者IPSS、QOL Qmax、血PSA、RU等指标进行统计分析.采用SPSS 13.0软件处理数据,均数间比较采用配对t检验.结果 33例手术经过顺利.28例术后3～4 d拔除导尿管,排尿情况改善明显;5例初次拔管后仍有排尿困难而再次留置导尿,延时拔管后均能自行排尿.术后并发症包括血尿14例、短暂尿失禁3例.术后1个月时IPSS、QOL、Q_(max)、血PSA、RU分别为14.6±2.8、3.1±0.4、(13.2±5.6)ml/s、(16.3±13.4)ng/ml、(24.6±5.9)ml;术后6个月时分别为14.2±3.3、3.4±0.5、(12.2±3.4)ml/s、(8.0±6.5)ng/ml、(31.1±8.7)ml.术后1、6个月的IPSS评分、QOL、Qmax、血PSA与术前比较差异均有统计学意义(P＜0.01),术后1、6个月间IPSS评分、QOL、Q_(max)比较差异无统计学意义(P＞0.05).结论 PVP可以有效解除前列腺癌患者的下尿路梗阻症状,明显改善患者生活质量.安全、有效.

abstractsObjective To evaluate the clinical safety and efficacy of photoselecticve vaporization of the prostate(PVP)with potassium-titanyl-'phosphate laser(KTP)in the treatment of lower urinary tract obstruction(LUTS)caused by advanced prostate cancer. Methods Clinical data of 33 patients with LUTS caused by advanced prostate cancer treated by PVP were analyzed retrospectively.The mean age was(76±6)years.A1l the cases were confirmed with prostate cancer with pathologic exami- nation.Of whom,1 8 were in clinical stage T3 and 1 5 in stage T4.Prostate volumes were 36-1 40 ml (53±28)m1.Preoperative and1-month,6-month follow up data of Quality of life(QOI.),International prostate symptom score(IPSS),maximum urinary flow rate(Qmax),PSA and residual urine(RU)were analyzed. Results There were 1 9 primary prostate cancer patients accepted both PVP and surgical castration and another 14 prostate cancer patients had LUTS after orchectomy.Of these patients.15 had a history of urinary retention.The pre-operative data of IPSS,QOL,Qmax,PSA and RU were 28.2±3.6,5.0±0.7,4.7-10.1 ml／s,54.9±34.8 ng／ml and 126.0±25.2 m1.All the surgeries went on successfully and 28 cases could urinate immediately after removal of the catheter 3-4 davs af-ter surgery.Five patients were with dysuria and re-catheterized and all of them had voluntary mieturi- tion in the end.The data of 1PSS,QOL,Q…,PSA and RU changed to 14.6±2.8,3.1±0.4,13.2 ±5.6,16.3±13.4,24.6±5.9 and 14.2±3.3,3.4±0.5,12.2±3.4,8.0±6.5,31.1±8.7 1 month and 6 months after PVP treatment respectively.Postoperative complications included hematuria and transient urinary incontinence.IPSS,QOL,Q_(max),PSA and RU improved significantly in patients after 1-month and 6-month followed up compared with preoperative data.There was no difference of IPSS,QOL,Qmax and RU comparing 1-month and 6-month data after PVP treatment. Conclusions PVP can be used safely and effectively to relieve LUTS caused by advanced prostate cancer and to improve the QOL,reduce the tumor load,postpone cancer progressing and will not cause tumor cell spreading.PVP is a safe,efficient and minimal invasive treatment therapeutic option for locally advanced prostate cancer.