Govorov A V, Vasil'ev A O, Ivanov V Iu, Kovylina M V, Prilepskaia E A, Pushkar' D Iu
Urologiia. 2014 Nov-Dec(6):69-72, 74.
Currently, the choice of tactics of treatment of the patient with prostate cancer (PCa) requires to take into account the degree of differentiation and stage of tumor, age of the patient and his somatic diseases, the risk of complications, as well as the patient's desire and physician's experience. Due to the progressive development of medical technology, interest in minimally invasive treatments for prostate cancer, such as cryoablation, interstitial brachytherapy and HIFU-therapy, has grown. Cryoablation of the prostate gland is a tissue ablation by local effects of very low temperatures and is minimally invasive, highly effective treatment for prostate cancer that can be used as the primary treatment, and in the case of tumor recurrence after radiotherapy. Focal cryoablation of the prostate allows to selectively destroy the known tumor with preservation of organ function and without reducing the quality of life of the patient. Focal therapy for prostate cancer is an alternative to radical treatment and active surveillance, occupying an intermediate position between them. Due to the lack of long-term results, focal cryoablation is an experimental type of treatment. First cryoablation of the prostate using modern equipment was carried out in Russia in March 2010, at the Department of Urology MSMSU. Since that time, we performed this procedure in 122 patients with prostate cancer; cryoablation was primary treatment in 110 patients and was used as salvage treatment in 12 patients. In most cases, the operation was performed under epidural or spinal anesthesia. According to the protocol, all the patients underwent 2 cycles of freezing and thawing under transrectal ultrasound guidance. A significant improvement of equipment for cryosurgery, the use of cryoneedles with smaller diameter, and the use of temperature sensors and catheters to warm the urethral mucosa have allowed to minimize the number of complications in comparison with other methods of treatment of prostate cancer and achieve a high disease-free survival. Our prospective study was aimed to analyze our own results cryoablation of the prostate gland.
目前，前列腺癌（PCa）患者治疗策略的选择需要考虑肿瘤的分化程度和分期、患者年龄及其躯体疾病、并发症风险，以及患者的意愿和医生的经验。由于医疗技术的不断发展，对前列腺癌微创治疗的兴趣与日俱增，如冷冻消融、组织间近距离放疗和高强度聚焦超声治疗（HIFU治疗）。前列腺冷冻消融是通过极低温度的局部效应进行的组织消融，是一种微创、高效的前列腺癌治疗方法，可作为一线治疗，也可用于放疗后肿瘤复发的情况。前列腺局灶性冷冻消融能够选择性地破坏已知肿瘤，同时保留器官功能且不降低患者的生活质量。前列腺癌的聚焦治疗是根治性治疗和主动监测之外的一种选择，处于两者之间的中间位置。由于缺乏长期结果，局灶性冷冻消融是一种试验性治疗方式。2010年3月，俄罗斯莫斯科第一国立医科大学泌尿外科首次使用现代设备对前列腺进行了冷冻消融。自那时起，我们对122例前列腺癌患者实施了该手术；其中110例患者将冷冻消融作为一线治疗，12例患者作为挽救性治疗。大多数情况下，手术在硬膜外或脊髓麻醉下进行。根据方案，所有患者在经直肠超声引导下接受2个冻融周期。与其他前列腺癌治疗方法相比，冷冻手术设备的显著改进、使用直径更小的冷冻针以及使用温度传感器和导管来加热尿道黏膜，使得并发症数量降至最低，并实现了较高的无病生存率。我们的前瞻性研究旨在分析我们自己开展的前列腺冷冻消融结果。
