Lange D, Bruce W, Grellier P
Clinique Tivoli, Bordeaux.
Ann Urol (Paris). 1990;24(2):103-8.
The authors report a series of 50 radical prostatectomies and analyse and discuss the elements of: early diagnosis of adenocarcinoma: 63% of patients did not have a strictly normal digital rectal examination, 70% had abnormal ultrasonography, 73% has a PSA assay greater than 10. Suspicious signs were absent in 17% of cases, but present in 83% of cases (one sign), 63% of cases (two signs) and 40% of cases (three signs). Ultrasound guided biopsy of suspicious zones (on rectal examination or on ultrasonography) and in adjacent zones by dividing the prostate into quadrants has an increasing diagnostic yield (77% of the last thirty cases, 100% of the last fifteen cases). Staging frequently underestimates the exact volume of the tumour and the state of the prostatic capsule. MRI using a high power magnetic field apparatus seems to improve the accuracy of preoperative staging. Operative results were excellent in terms of mortality (nil), morbidity (6% of cases) and functional results for continence (recovered within one month) and sexual activity (satisfactory in 73% of cases) when Walsh's technique was able to be applied.
作者报告了一系列50例根治性前列腺切除术，并分析和讨论了以下内容：腺癌的早期诊断：63%的患者直肠指检结果并非完全正常，70%的患者超声检查异常，73%的患者前列腺特异性抗原（PSA）检测值大于10。17%的病例无可疑体征，但83%的病例有可疑体征（1种体征）、63%的病例有2种体征以及40%的病例有3种体征。通过将前列腺划分为象限，对可疑区域（直肠指检或超声检查时发现）及相邻区域进行超声引导下活检，诊断率不断提高（最后30例中为77%，最后15例中为100%）。分期常常会低估肿瘤的实际大小和前列腺包膜的状态。使用高功率磁场设备进行的磁共振成像（MRI）似乎能提高术前分期的准确性。当能够应用沃尔什技术时，手术结果在死亡率（零）、发病率（6%的病例）以及控尿功能结果（1个月内恢复）和性功能结果（73%的病例满意）方面都非常出色。
