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目的 探讨经会阴超声引导放射性1 2 5I粒子近距离治疗前列腺癌的近期疗效和并发症。方法 32例前列腺癌患者实施经会阴超声引导放射性1 2 5I粒子植入术 ,11例单纯粒子治疗 ,6例术前或术后配合外放疗。 15例粒子植入术后加睾丸去势术。连续 3次前列腺特异抗原 (prostatespecificantigen ,PSA)升高即为生物化学失败。结果 14例原发前列腺癌粒子植入治疗前和治疗后血清PSA分别为 (5 2 14± 5 4 6 1)ng ml和 (4 2 6± 7 11)ng ml,统计学处理差异有显著性 (t=3 2 5 3,P =0 0 0 3) ,生物化学控制率为 10 0 %。 12例去势术后复发患者1 2 5I粒子植入治疗前和治疗后PSA分别为 (15 14± 2 0 80 )ng ml和 (18 94± 35 2 5 )ng ml(t=- 0 30 7,P =0 76 4 ) ,统计学处理差异无显著性 ,生物化学控制率为 75 %。 5例骨转移患者术前和术后PSA分别为 (12 0 0 3± 14 5 96 )ng ml和(75 5 3± 84 84 )ng ml(t =0 5 2 7,P =0 6 2 1) ,统计学处理差异无显著性。1 2 5I粒子单纯植入治疗34 6 2 %患者无尿道副反应 ,Ⅰ～Ⅴ级尿道副反应发生率分别为 38 4 6 %、11 5 4 %、11 5 4 %、0和3 85 %。1 2 5I粒子植入联合外放疗组Ⅰ～Ⅳ级副反应发生率分别为 16 6 7%、0、0和 16 6 7%。Ⅰ级直肠副反应发生率为 3 12 %
Objective To investigate the short-term effects and complications of transrectal ultrasound guided radioactive 125 I seeds in the treatment of prostate cancer. Methods Thirty-two cases of prostate cancer underwent transperineal guided radioactive 125I particle implantation, 11 cases of simple particle therapy and 6 cases of preoperative or postoperative external radiotherapy. Fifteen patients undergone testicular castration after implantation. Three consecutive prostatitis specific antigens (PSA) increase is biochemical failure. Results The serum PSA levels of 14 cases of primary prostate cancer before and after treatment were (5214 ± 5461) ng ml and (4226 ± 711) ng ml, respectively, and the difference was statistically significant (t = 3 2 5 3, P = 0 0 0 3). The biochemical control rate was 100%. The PSA levels in 125 patients with 125 IU after 125 IU implantation were (15 14 ± 2 0 80) ng ml and (18 94 ± 35 25) ng ml (t = - 0 30 7 , P = 0 76 4). There was no significant difference in statistical analysis. The biochemical control rate was 75%. Preoperative and postoperative PSA in 5 patients with bone metastasis were (12 0 ± 14 5 96) ng ml and (75 5 3 ± 84 84) ng ml (t = 0 5 2 7, P = 0 6 2 1 ), No statistically significant difference. The 125I seeds were implanted alone in 34 6 2% of the patients without urethral adverse reactions. The incidence of grade Ⅰ to Ⅴ urethral adverse reactions were 38 4 6%, 11 5 4%, 11 5 4%, 0 3 85%, respectively. The incidence of grade Ⅰ ~ Ⅳ side effects of 125 I seed implantation combined with external radiotherapy were 16 6 7%, 0 0 and 16 6 7% respectively. Grade Ⅰ rectal side effects occurred in 3 12%