颜　冰　付杰新　刘勇刚　李玉莹　黄恒前

【摘要】 目的 探讨晚期前列腺癌(PCa)伴尿道梗阻患者的治疗方法。方法 采用经尿道前列腺汽化电切术(TUVP),结合睾丸切除去势术和联合非甾体类抗雄激素(口服氟他胺或康士德)，作雄激素阻断治疗。随访时间6~36个月。结果 术后5~7 d拔除导尿管，排尿通畅，结合睾丸切除去势术和联合非甾体类抗雄激素的全雄激素阻断治疗后6~12个月复查，B 超、MRI或CT等检查显示前列腺明显缩小；直肠指检前列腺质地变软；PSA明显下降；术前发现的骨转移经治疗后骨痛明显减轻，ECT检查骨转移破坏未见发展。随访6~36个月，临床症状明显改善，排尿满意，全部带瘤存活。结论 晚期(PCa)压迫尿道致排尿困难时采用TUVP能够缓解膀胱出口梗阻的症状，为内分泌治疗创造有利条件，同时予睾丸切除去势术联合内分泌治疗，可限制和延缓肿瘤的生长发展，亦可巩固TUVP的疗效，是前列腺癌伴尿道压迫梗阻症状的理想治疗手段。

【关键词】前列腺癌；尿道梗阻；经尿道前列腺汽化电切术；去势术；内分泌治疗

Analysis of the efficacy of TUVP combined with endocrine therapy of advanced prostatic cancer(report of 45 cases)

YAN Bing,FU Jie-xin,LIU Yong-gang,et al.Department of Urogy,The First Hospital of Nanning,Nanning 530022,China

【Abstract】 Objective To evaluate the treatment methods of advanced prostatic cancer(PCa)with urethral obstruction.Methods Using transurethral electrovaporation of prostate combined with orchiectomy emasculation and non-steroidal antiandrogen(oral Flutamide or Casodex),total androgen blockade.Time of follow-up lasted range 6 to 36 months.Results The catheter was removed 5~7 days after the operation,all with fluent urination.After treatment for 6-12 months,Examined with B ultrasonography,CT or MRI revealed the volume of prostate was reduced markedly,The texture of prostate were softening in digital rectal examination,PSA decreased obviously，The bone pain in patients with metastatic bone found before the operation recovered after treated,ECT did not show bone metastasis development.The patients were followed up for 6~36 months,the clinical symptoms were relieved significantly,urinated well,all patients are alive with neoplasm.Conclusion TUVP can relieve the bladder outlet obstruction symptoms whendysuria by advanced prostatic neoplasms,create favourable conditions for the endocrine therapy，when orchiectomy combined with endocrine therapy.Can limit and delaying the growth developing of tumor,consolidate effect of TUVP.It is an optimal method to cure prostate cancer and urethral obstruction.

【Key words】Prostate cancer；Urethral obstruction；Transurethral electrovaporation of prostate；Emasculation；Endocrine therapy

前列腺癌(PCa)的发病率在欧美国家位于泌尿系统肿瘤的第一位，国内则仅低于膀胱癌位于第2位，近年来有明显上升趋势^[1]。晚期PCa肿块压迫尿道时，患者出现排尿困难甚至发生尿潴留，严重影响患者生活质量。南宁市第一人民医院自2002年3月至2007年3月对45例中、晚期PCa伴有排尿困难症状的患者采用经尿道前列腺汽化电切术(TUVP)、结合睾丸切除去势

术和联合非甾体类抗雄激素(口服氟他胺或康士德)治疗，经临床随访效果满意，现报告如下。……