近距離治療計劃系統(tǒng)（TPS）在前列腺癌診治中的應用
發(fā)布時間：2018-09-04 09:54
【摘要】：目的:1.探討模板定位下經(jīng)會陰前列腺投影超飽和穿刺(以下簡稱“前列腺投影穿刺”)在臨床疑診為前列腺癌(prostatic cancer,PCa)但首次活檢陰性患者中的診斷價值,評價其有效性和安全性。2.探討125I粒子前列腺植入近距離治療去勢抵抗性前列腺癌(castration resistant prostate cancer,CRPC)的臨床療效。3.探討經(jīng)會陰模板下前列腺飽和穿刺(transperineal template-guided prostate saturation biopsy,TTPSB)對勃起功能的影響。方法:1.將218例首次經(jīng)會陰穿刺活檢診斷為前列腺良性病變,但前列腺特異性抗原(prostate specific antigen,PSA)持續(xù)4.0μg/L 或直腸指檢(digital rectal examination,DRE)及 MRI陽性,臨床高度懷疑PCa患者納入研究。按再次穿刺的方法不同分為投影穿刺組和飽和穿刺組。按不同前列腺體積(40ml、40-80ml、80ml)比較兩組穿刺的陽性率以及術(shù)后肉眼血尿、發(fā)熱、尿潴留和會陰不適(腫脹、出血)等并發(fā)癥的發(fā)生率,并且使用ⅡEF-5(5-item version of the International Index of Erectile Function)對觀察組穿刺前與穿刺后 1 月、3 月和6月的勃起功能進行比較。2.將2010年2月至2016年3月我院收治的31例CRPC患者根據(jù)治療方案的不同分成兩組,內(nèi)分泌治療組14例進行單純內(nèi)分泌治療,近距離治療組17例行超聲引導下經(jīng)會陰穿刺1251粒子植入聯(lián)合內(nèi)分泌治療,比較兩組患者術(shù)后PSA無進展生存時間、總生存時間和生活質(zhì)量。3.前瞻性入組2013年6月至2015年10月間來我院行前列腺穿刺的患者,依據(jù)患者病情、恥骨的解剖條件和個人意愿等因素分為觀察組(TTPSB)和對照組(傳統(tǒng)經(jīng)陰模板下前列腺穿刺)。為排除穿刺結(jié)果給患者帶來的焦慮從而引起的勃起功能障礙(erectile dysfunction,ED),并且剔除中途退出試驗、失訪及使用改善性功能藥物(如5-磷酸二酯酶抑制劑等)的患者,最終觀察組和對照組分別有97例和84例穿刺結(jié)果為前列腺增生(benign prostatic hyperplasia,BPH)的患者納入分析。采用ⅡEF-5對患者穿刺前以及穿刺后1月、3月和6月的勃起功能進行評估。結(jié)果1.投影穿刺組總體穿刺陽性率及前列腺體積80ml者的陽性率均顯著高于飽和穿刺組(P=0.044;P==0.041)。投影穿刺組術(shù)后出現(xiàn)血尿、發(fā)熱、尿潴留和會陰不適的概率比飽和穿刺組高,但差異均無統(tǒng)計學意義(P0.05)。前列腺投影穿刺前的ⅡEF-5評分的中位數(shù)為18.7,穿刺后1月的ⅡEF-5評分的中位數(shù)為17.3,與穿刺前相比差異有統(tǒng)計學意義(P0.05),但是穿刺后3月和6月的ⅡEF-5評分的中位數(shù)分別為18.2、18.5,與穿刺前相比差異均無統(tǒng)計學意義(P0.05)。2.近距離治療組中位PSA無進展及總體生存時間分別為29(25～37)月和37(30～50)月,與內(nèi)分泌治療組的13(7～22)、18(14～24)月比較均有統(tǒng)計學差異(P0.05)。對于兩組患者治療后的生活質(zhì)量,近距離治療組患者的尿路癥狀在治療后1月與內(nèi)分泌治療組相比有統(tǒng)計學差異并有臨床相關(guān)惡化,但術(shù)后6月以后與內(nèi)分泌治療組相比無統(tǒng)計學意義且無臨床相關(guān)惡化;并且近距離治療組患者的生理功能、社會功能、總健康水平和一般軀體不適與內(nèi)分泌治療組相比有明顯的提高。3.觀察組和對照組患者穿刺前ⅡEF-5評分分別平均為19.1±4.5和19.7±4.3,兩者比較無統(tǒng)計學差異(t=0.890,P=0.375);穿刺后1月兩組患者的ⅡEF-5評分分別為17.4±4.8和18.2±4.5,與穿刺前相比均有統(tǒng)計學差異(P0.05),但是穿刺后3月和6月兩組患者的ⅡEF-5評分與穿刺前相比均無統(tǒng)計學意義(P0.05),并且各時間段觀察組和對照組相比也無統(tǒng)計學差異(P0.05)。結(jié)論1.對于首次穿刺陰性但高度懷疑PCa的患者,前列腺投影穿刺可以提高穿刺的陽性率,更加準確的定位PCa,且穿刺后并發(fā)癥發(fā)生率無明顯增加,可以成為前列腺穿刺活檢安全可靠的方法。2.近距離治療CRPC能有效延長患者生存期,并且在一定程度上提高患者的生活質(zhì)量。3.TTPSB可能導致短暫性(術(shù)后1月)的ⅡEF-5評分降低,但是與傳統(tǒng)模板定位下經(jīng)會陰前列腺穿刺活檢(transperineal template prostate biopsies,TTPB)相比,沒有加重對勃起功能的影響,并且勃起功能在穿刺后3～6個月恢復到穿刺前水平。
[Abstract]:Objective: 1. To evaluate the diagnostic value and safety of template-guided transperineal prostate projection hypersaturation puncture (PCP) in patients with suspected prostate cancer (PCa) but negative for the first biopsy. 2. To evaluate the efficacy and safety of 125I seed prostate implantation in brachytherapy for castration resistance. Objective:To investigate the effect of transperineal template-guided prostate saturation biopsy (TTPSB) on erectile function in patients with prostate cancer (CRPC). Methods: 218 cases of benign prostate lesions were diagnosed by transperineal template-guided prostate saturation biopsy (TTPSB) for the first time. Patients with highly suspected PCa were included in the study. They were divided into projection puncture group and saturation puncture group according to the method of re-puncture. Sexual rate and incidence of postoperative complications such as naked eye hematuria, fever, urinary retention and episiorrhea (swelling, bleeding) were compared with those before puncture and 1, 3, and 6 months after puncture in the observation group by using 2 EF-5 (5-item version of the International Index of Erectile Function). Thirty-one patients with CRPC were divided into two groups according to different treatment schemes. 14 patients in endocrine therapy group were treated with endocrine therapy alone. 17 patients in brachytherapy group were treated with ultrasound-guided transperineal 1251 seed implantation combined with endocrine therapy. From June 2013 to October 2015, prostatic patients undergoing prostate biopsy in our hospital were divided into observation group (TTPSB) and control group (traditional transvaginal prostate biopsy) according to the patient's condition, pubic anatomical conditions and personal wishes. Patients with ile dysfunction, ED, and withdrawal from the trial, loss of visit and use of sex-improving drugs (e.g. 5-phosphodiesterase inhibitors) were excluded. 97 patients with benign prostatic hyperplasia (BPH) were included in the final observation group and 84 patients in the control group, respectively. Results 1. The overall positive rate of puncture and the positive rate of 80 ml prostate volume in the projection puncture group were significantly higher than those in the saturation puncture group (P = 0.044; P = 0.041). The median score of IIEF-5 before prostate projection puncture was 18.7, and that of IIEF-5 one month after puncture was 17.3, which was significantly different from that before puncture (P 0.05). However, the median scores of IIEF-5 at 3 months and 6 months after puncture were 18.2 and 18.5, respectively, which had no statistical difference compared with that before puncture. Significance (P 0.05). 2. The median PSA progression and overall survival time in the brachytherapy group were 29 (25-37) months and 37 (30-50) months, respectively, which were significantly different from those in the endocrine group at 13 (7-22) and 18 (14-24) months (P 0.05). Compared with the endocrine treatment group, there were statistical differences and clinical related deterioration, but there was no statistical significance and no clinical related deterioration between the endocrine treatment group and the endocrine treatment group after 6 months. The scores of the observation group and the control group were 19.1 (+ 4.5) and 19.7 (+ 4.3) respectively before puncture, and there was no significant difference between the two groups (t = 0.890, P = 0.375); the scores of the two groups were 17.4 (+ 4.8) and 18.2 (+ 4.5) one month after puncture, respectively, which were significantly different from those before puncture (P 0.05). There was no significant difference between pre-puncture and pre-puncture scores (P 0.05), and there was no significant difference between the observation group and the control group (P 0.05). Prostate biopsy can be a safe and reliable method. 2. Proximal treatment of CRPC can effectively prolong the survival of patients, and to a certain extent improve the quality of life. 3. TTPSB may lead to temporary (1 month after surgery) II EF-5 score decreased, but with the traditional template positioning transperineal prostate biopsy (tra) Compared with TTPB, TTPB did not aggravate the effect on erectile function, and erectile function returned to pre-puncture level 3-6 months after puncture.
【學位授予單位】：揚州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.25
本文編號：2221736
[Abstract]:Objective: 1. To evaluate the diagnostic value and safety of template-guided transperineal prostate projection hypersaturation puncture (PCP) in patients with suspected prostate cancer (PCa) but negative for the first biopsy. 2. To evaluate the efficacy and safety of 125I seed prostate implantation in brachytherapy for castration resistance. Objective:To investigate the effect of transperineal template-guided prostate saturation biopsy (TTPSB) on erectile function in patients with prostate cancer (CRPC). Methods: 218 cases of benign prostate lesions were diagnosed by transperineal template-guided prostate saturation biopsy (TTPSB) for the first time. Patients with highly suspected PCa were included in the study. They were divided into projection puncture group and saturation puncture group according to the method of re-puncture. Sexual rate and incidence of postoperative complications such as naked eye hematuria, fever, urinary retention and episiorrhea (swelling, bleeding) were compared with those before puncture and 1, 3, and 6 months after puncture in the observation group by using 2 EF-5 (5-item version of the International Index of Erectile Function). Thirty-one patients with CRPC were divided into two groups according to different treatment schemes. 14 patients in endocrine therapy group were treated with endocrine therapy alone. 17 patients in brachytherapy group were treated with ultrasound-guided transperineal 1251 seed implantation combined with endocrine therapy. From June 2013 to October 2015, prostatic patients undergoing prostate biopsy in our hospital were divided into observation group (TTPSB) and control group (traditional transvaginal prostate biopsy) according to the patient's condition, pubic anatomical conditions and personal wishes. Patients with ile dysfunction, ED, and withdrawal from the trial, loss of visit and use of sex-improving drugs (e.g. 5-phosphodiesterase inhibitors) were excluded. 97 patients with benign prostatic hyperplasia (BPH) were included in the final observation group and 84 patients in the control group, respectively. Results 1. The overall positive rate of puncture and the positive rate of 80 ml prostate volume in the projection puncture group were significantly higher than those in the saturation puncture group (P = 0.044; P = 0.041). The median score of IIEF-5 before prostate projection puncture was 18.7, and that of IIEF-5 one month after puncture was 17.3, which was significantly different from that before puncture (P 0.05). However, the median scores of IIEF-5 at 3 months and 6 months after puncture were 18.2 and 18.5, respectively, which had no statistical difference compared with that before puncture. Significance (P 0.05). 2. The median PSA progression and overall survival time in the brachytherapy group were 29 (25-37) months and 37 (30-50) months, respectively, which were significantly different from those in the endocrine group at 13 (7-22) and 18 (14-24) months (P 0.05). Compared with the endocrine treatment group, there were statistical differences and clinical related deterioration, but there was no statistical significance and no clinical related deterioration between the endocrine treatment group and the endocrine treatment group after 6 months. The scores of the observation group and the control group were 19.1 (+ 4.5) and 19.7 (+ 4.3) respectively before puncture, and there was no significant difference between the two groups (t = 0.890, P = 0.375); the scores of the two groups were 17.4 (+ 4.8) and 18.2 (+ 4.5) one month after puncture, respectively, which were significantly different from those before puncture (P 0.05). There was no significant difference between pre-puncture and pre-puncture scores (P 0.05), and there was no significant difference between the observation group and the control group (P 0.05). Prostate biopsy can be a safe and reliable method. 2. Proximal treatment of CRPC can effectively prolong the survival of patients, and to a certain extent improve the quality of life. 3. TTPSB may lead to temporary (1 month after surgery) II EF-5 score decreased, but with the traditional template positioning transperineal prostate biopsy (tra) Compared with TTPB, TTPB did not aggravate the effect on erectile function, and erectile function returned to pre-puncture level 3-6 months after puncture.
【學位授予單位】：揚州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.25
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