Onik G M, Cohen J K, Reyes G D, Rubinsky B, Chang Z, Baust J
Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA 15212.
Cancer. 1993 Aug 15;72(4):1291-9. doi: 10.1002/1097-0142(19930815)72:4<1291::aid-cncr2820720423>3.0.co;2-i.
The two major treatments for prostate cancer, radical prostatectomy and radiation therapy, are associated with considerable morbidity and variable results. This article presents the preliminary results using percutaneous radical cryosurgical ablation under ultrasound guidance to treat prostate cancer.
The patient group consisted of all patients with localized prostate cancer who underwent cryosurgery between June 1, 1990 and May 1, 1992. Patients in Group 1 were treated by freezing of the tumor with two cryoprobes placed multiple times. Group 2 patients were treated by freezing of the tumor with five cryoprobes placed simultaneously. Cryoprobes (3 mm in diameter) were placed percutaneously with a transperineal approach. Cryoprobe placement and freezing were monitored using the transrectal ultrasound.
Of the 55 patients (68 procedures) undergoing treatment, 23 have 3 months of follow-up with associated biopsy (Group 1, 8 patients; Group 2, 15 patients). In Group 1, three (37.5%) patients had residual disease. In Group 2, one (6.7%) patient had residual disease, whereas 14 (93.3%) patients did not. Combining both groups, 19 (82.6%) patients had no residual disease, whereas 4 (17.4%) patients had positive results on postoperative biopsy. Complications included rectal freezing, urethrorectal fistula, sloughing urethral tissue, impotence, perineal ecchymosis, penile edema, and ileus.
Preliminary results indicate that percutaneous transperineal ultrasound-guided prostate cryosurgery may be an effective treatment for prostate cancer with minimal associated morbidity.
前列腺癌的两种主要治疗方法，根治性前列腺切除术和放射治疗，都伴有相当程度的发病率且效果各异。本文介绍了在超声引导下经皮根治性冷冻手术消融治疗前列腺癌的初步结果。
患者组包括1990年6月1日至1992年5月1日期间接受冷冻手术的所有局限性前列腺癌患者。第1组患者通过使用两根冷冻探头多次冷冻肿瘤进行治疗。第2组患者通过同时使用五根冷冻探头冷冻肿瘤进行治疗。直径3毫米的冷冻探头经会阴途径经皮放置。使用经直肠超声监测冷冻探头的放置和冷冻过程。
在接受治疗的55例患者（68次手术）中，23例有3个月的随访及相关活检（第1组8例患者；第2组15例患者）。在第1组中，3例（37.5%）患者有残留病灶。在第2组中，1例（6.7%）患者有残留病灶，而14例（93.3%）患者没有。两组合计，19例（82.6%）患者无残留病灶，而4例（17.4%）患者术后活检结果为阳性。并发症包括直肠冷冻、尿道直肠瘘、尿道组织脱落、阳痿、会阴瘀斑、阴茎水肿和肠梗阻。
初步结果表明，经会阴超声引导下经皮前列腺冷冻手术可能是一种治疗前列腺癌的有效方法，且相关发病率最低。
