低危前列腺癌125I粒子植入治疗尿路合并症的临床分析

doi:10.3969/j.issn.1006-7795.2017.02.031

摘要/Abstract

摘要： 目的探讨¹²⁵I粒子近距离放射治疗低危前列腺癌术后不良反应及合并症的发生、发展及预后。方法回顾性分析了2007年1月至2015年6月收治的30例前列腺癌病人的临床资料。年龄65~85岁，平均年龄（78.1±5.30）岁。前列腺表面特异性抗原（prostate specific antigen，PSA）4.15~9.8 ng/mL，平均（8.25±1.04）ng/mL，临床TNM分期T_1c~T_2aN₀M₀，Gleason评分5~7分。前列腺体积38~55 mL，平均（49.1±3.92）mL。在连续硬膜外麻醉下，经直肠超声扫描前列腺，图像传送至计算机计划系统，根据计划行经会阴¹²⁵I粒子植入术。结果 30例病人植入粒子45~70粒，平均（52.6±6.77）粒。全部病人获得随访，随访时间为12~86个月，平均（40.4±7.01）个月。术后1个月尿路Ⅰ、Ⅱ、Ⅲ、Ⅳ级不良反应发生率分别为66.67%、20%、6.67%、0;术后12个月尿路Ⅰ、Ⅱ级不良反应发生率分别为10%、3.33%，无Ⅲ、Ⅳ级不良反应，缓解率为85.71%。结论 ¹²⁵I粒子植入术治疗低危前列腺癌术后急性尿路不良反应较普遍，但程度多较轻且有自限性，经保守治疗大部分于1年内缓解，极少数可能进展为远期严重合并症。术中精确的定位、制定计划及粒子植入操作技术是预防严重合并症的关键。

关键词: 前列腺癌, ¹²⁵I粒子, 近距离放射治疗, 合并症

Abstract: Objective To analyze the side effects and complication of low-risk prostate cancer after ¹²⁵I seeds prostate implant. Methods A total of 30 prostate cancer patients with age ranging from 65 to 85 years[average age of (78.1±5.30) years] were recruited. All patients were treated between January 2007 and June 2015. The prostate specific antigen (PSA) level of these patients was 4.15-9.8 ng/mL[average (8.25±1.04) ng/mL], and the Gleasons Score was 5-7. All patients were clinically staged as T_1c-T_2aN₀M₀; 30 cases with prostate volume of 38-55 mL, an average of (49.1±3.92) mL. Under continual epidural anesthesia, these patients underwent trans-rectal ultrasound. Pictures were transmitted to the computer system to make plan. According to the plan, patient received ¹²⁵I seed brachytherapy under the guidance of the trans-rectal ultrasound. Results All 30 cases were implanted seeds of 45-70 (average seeds of 52.6±6.77). The follow-up period was 12-86 months, with average of (40.4±7.01) months. The urinary side effects of gradeⅠ, Ⅱ, Ⅲ, and Ⅳ were 66.67% and 20% and 6.67% and 0 one month after seeds implant. By conservative treatment, the urinary side effects of gradeⅠand Ⅱwere 10% and 3.33% 12 months after seeds implant. No grade Ⅲ and Ⅳ side effects were found. Symptom remission rate was 85.71%. Conclusion Urinary side effects are common after prostate brachytherapy but are mostly self-limiting in the majority of patients, such side effects resolve within a year after the procedure. Serious complications of grade Ⅳ are rare. Intraoperative accurate localization and making plan and implantation are the key to the prevention of serious complications.

Key words: prostate cancer, ¹²⁵I seed, brachytherapy, complication

中图分类号:

张继伟, 阎乙夫, 夏溟. 低危前列腺癌¹²⁵I粒子植入治疗尿路合并症的临床分析[J]. 首都医科大学学报, 2017, 38(2): 325-328.

Zhang Jiwei, Yan Yifu, Xia Ming. Clinical analysis of urinary complications of ¹²⁵I seeds implant in patients of low-risk prostate cancer[J]. Journal of Capital Medical University, 2017, 38(2): 325-328.

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低危前列腺癌¹²⁵I粒子植入治疗尿路合并症的临床分析

Clinical analysis of urinary complications of ¹²⁵I seeds implant in patients of low-risk prostate cancer

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