Pond H S, Rutherford C L, Cooner W H, Mosley B R, Beard F H
South Med J. 1978 May;71(5):541-2. doi: 10.1097/00007611-197805000-00018.
There is sharp disagreement as to what constitutes the proper surgical approach to localized carcinoma of the prostate. We have performed 31 radical perineal prostatectomies in a six-year period with no mortality and minimal morbidity. Thirteen of these patients were understaged preoperatively and had extraprostatic cancer; however, only one has died from his tumor. One patient is incontinent but none has troublesome local symptoms. These patients required an average of 15 postoperative days, none required more than two units of blood, and careful preoperative consultation has minimized the psychologic stress of impotence. These data contrast sharply with the published morbidity and mortality statistics associated with a preliminary staging lymphadenectomy and a definitive radical retropubic prostatectomy. Also, we are convinced that our patients with stage C cancer have been done a real service by removing the prostate gland even though cancer remains in the stumps of the seminal vesicles. Unless the advocates of the staged procedure can demonstrate an improvement in the patients' survival data, we believe the radical perineal prostatectomy remains the procedure of choice for the cure of localized prostatic cancer and we would advocate this operation as an acceptable palliative approach to selected patients with stage C lesions.
对于什么是治疗局限性前列腺癌的恰当手术方法，存在着严重的分歧。我们在六年时间里进行了31例经会阴根治性前列腺切除术，无一例死亡，发病率也极低。其中13例患者术前分期不准确，存在前列腺外癌；然而，只有1例死于肿瘤。有1例患者出现尿失禁，但没有患者有令人困扰的局部症状。这些患者术后平均住院15天，无一例需要超过两个单位的血液，并且术前的仔细咨询将阳痿带来的心理压力降到了最低。这些数据与已发表的关于初步分期淋巴结清扫术和根治性耻骨后前列腺切除术的发病率和死亡率统计数据形成了鲜明对比。此外，我们确信，对于患有C期癌症的患者，即使精囊残端仍有癌细胞，切除前列腺也确实为他们提供了帮助。除非分期手术的支持者能够证明患者的生存数据有所改善，否则我们认为经会阴根治性前列腺切除术仍然是治疗局限性前列腺癌的首选方法，并且我们主张将这种手术作为治疗某些C期病变患者的一种可接受的姑息性方法。
