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目的探讨睾丸切除加抗雄激素联合膀胱穿刺造瘘治疗伴尿潴留的晚期前列腺癌的疗效。方法对21例伴尿潴留的晚期前列腺癌患者行双侧睾丸切除及膀胱穿刺造瘘术,同时口服抗雄激素药物,伴骨转移患者每月静脉滴注磷酸盐类药物。结果 21例患者手术时间(23±5)min,术中出血量均<10ml。术后3个月复查前列腺特异性抗原(PSA)下降至0.1~2.6ng/ml,睾酮达去势水平,肾脏积水明显好转,肾功能均恢复正常,伴骨转移患者骨痛等症状明显缓解。5例在术后26~42个月进展为去势抵抗性前列腺癌,予多西他赛联合强的松治疗后,一般情况好转,PSA 0.26~2.14ng/ml,无一例患者死亡。结论对于伴尿潴留的晚期前列腺癌患者,采用睾丸切除加抗雄激素联合膀胱穿刺造瘘是一种较为简单、安全的方法。
Objective To investigate the efficacy of orchiectomy combined with anti-androgen combined with bladder puncture for the treatment of advanced prostate cancer with urinary retention. Methods Twenty-one patients with advanced prostate cancer with urinary retention underwent bilateral orchiectomy and bladder puncture and ostomy. Meanwhile, patients with oral anti-androgen therapy and bone metastasis were given intravenous drip of phosphate daily. Results The operation time of 21 patients (23 ± 5) min and intraoperative blood loss were less than 10ml. Prostate specific antigen (PSA) was reduced to 0.1-2.6ng / ml at 3 months after operation. The testosterone up-castrated, renal hydronephrosis improved significantly, renal function returned to normal, and bone pain and other symptoms were relieved in patients with bone metastasis . Five patients progressed to castrated resistant prostate cancer 26 to 42 months postoperatively. After treatment with docetaxel and prednisone, the general improvement was achieved with PSA 0.26 to 2.14 ng / ml, none of whom died. Conclusion For patients with advanced prostate cancer with urinary retention, the use of orchiectomy and anti-androgen combined with bladder puncture fistula is a relatively simple and safe method.