Agarwal Mayank, Agrawal Madhu Sudan
Department of Surgery, S. N. Medical College, Agra, India ; 4/18c, Bagh Farzana, Civil Lines, Agra, 282002 Uttar Pradesh India.
Urology Division, Department of Surgery, SN Medical College, Agra, Uttar Pradesh 282002 India.
Indian J Surg. 2015 Feb;77(1):23-7. doi: 10.1007/s12262-012-0741-z. Epub 2012 Sep 18.
To study the effectiveness of bilateral subepididymal orchiectomy compared to bilateral simple and subcapsular orchiectomy in terms of androgen ablation, control of disease progression and esthetic superiority. 114 patients of advanced prostatic carcinoma (T3, T4, M1) were randomized to 3 groups- Group A: bilateral simple orchiectomy (38 patients), Group B: bilateral subcapsular orchiectomy (38 patients), & Group C: bilateral subepididymal orchiectomy (38 patients). Serum PSA and serum testosterone values were checked pre-operatively and at 3 months follow-up. Patients' esthetic satisfaction was scored on a quality of life scale of 1-5. In Groups A, B and C, at 3 months the post-operative mean serum testosterone values were 34.7, 38.1 and 36.7 ng/dl (p = 0.0524); and mean serum PSA values were 4.2, 3.9 and 3.4 ng/ml (p = 0.09) respectively, the differences not being statistically significant. On esthetic satisfaction scale the average scores were 1.8, 2.7 and 4.0 respectively, the difference being highly significant (p < 0.0001). Subepididymal orchiectomy maintains esthetic appearance of scrotum and provides superior patient satisfaction as compared to standard total and subcapsular orchiectomy, while achieving equal efficacy. Bilateral sub-epididymal orchiectomy may thus be considered procedure of choice to achieve androgen ablation in advanced prostatic carcinoma.
为研究双侧附睾下睾丸切除术与双侧单纯性及包膜下睾丸切除术相比，在雄激素去除、疾病进展控制和美学优势方面的有效性。114例晚期前列腺癌（T3、T4、M1）患者被随机分为3组——A组：双侧单纯性睾丸切除术（38例患者），B组：双侧包膜下睾丸切除术（38例患者），C组：双侧附睾下睾丸切除术（38例患者）。术前及术后3个月随访时检查血清前列腺特异抗原（PSA）和血清睾酮值。根据1 - 5的生活质量量表对患者的美学满意度进行评分。在A组、B组和C组中，术后3个月时的平均血清睾酮值分别为34.7、38.1和36.7 ng/dl（p = 0.0524）；平均血清PSA值分别为4.2、3.9和3.4 ng/ml（p = 0.09），差异无统计学意义。在美学满意度量表上，平均得分分别为1.8、2.7和4.0，差异具有高度统计学意义（p < 0.0001）。与标准的全睾丸切除术和包膜下睾丸切除术相比，附睾下睾丸切除术能保持阴囊的美观外观，并使患者满意度更高，同时疗效相当。因此，双侧附睾下睾丸切除术可被视为晚期前列腺癌雄激素去除的首选手术方式。
