【摘要翻译】联合应用HIFU和TURP治疗局灶性前列腺癌：可行性研究

[文题]TRANSRECTAL FOCUSED ULTRASOUND COMBINED WITH TRANSURETHRAL RESECTION OF THE PROSTATE FOR THE TREATMENT OF LOCALIZED PROSTATE CANCER: FEASIBILITY STUDY.
联合应用经直肠聚焦超声和经尿道前列腺切除治疗局灶性前列腺癌：可行性研究
[来源]Journal of Urology.
[年、卷、期、页]2004. 171(6, Part 1 of 2):2265-2267
[作者]VALLANCIEN, GUY; PRAPOTNICH, DOMINIQUE; CATHELINEAU, XAVIER; BAUMERT, HERVE; ROZET, FRANCOIS
[原文摘要]
Purpose: We studied the feasibility of combined treatment with high intensity focused ultrasound (HIFU) and transurethral resection or incision of the prostate for localized prostate cancer to decrease the risk of posttreatment prolonged urinary retention.
Materials and Methods: Included in this feasibility study were 30 patients fulfilling certain criteria, namely localized prostate cancer indicated for HIFU, age 60 years or older, prostate volume 45 cc or less, no more than 4 positive samples at sextant biopsy, baseline prostate specific antigen (PSA) 10 ng/ml or less and no evidence of cancer extension. They received the combined treatment under general anesthesia using an Ablatherm HIFU device (EDAP SA, Lyon, France).
Results: The enrolled patients were a mean of 72 years old and presented with a median prostate volume of 30 cc. Median Gleason score was 6, median PSA was 7 ng/ml and pretreatment sextant biopsies provided a median of 2 positive samples. Mean operative time was 2 hours 48 minutes, including resection and HIFU. An average of 616 HIFU shots were delivered. The urinary catheter was removed at day 2 after treatment. Median hospital stay was 3 days. Only a few complications were observed. In regard to the oncological aspects at a mean of 20 months of followup 86% of the patients had negative biopsies after HIFU. Median PSA was 0.9 ng/ml. At 1 year of followup the mean International Prostate Symptom Score was 8. Regarding sexual function, 73% of previously potent patients reported preserved sexual activity.
Conclusions: The combination of endoscopic resection or incision of the prostate with HIFU treatment decreases urinary catheterization time and improves posttreatment urinary status without additional morbidity.

[中文译文]
目的：研究联合应用高能聚焦超声（HIFU）和经尿道前列腺切除或切开治疗局灶性前列腺癌以降低治疗后尿潴留发生率的可行性。
材料和方法：符合以下标准的患者共30例：局灶性前列腺癌适合HIFU，年龄不小于60岁，前列腺体积不超过45cc，六点活检阳性标本不超过4个，基础PSA不超过10ng/ml，无肿瘤扩散的证据。患者均于全麻下接受联合治疗，所用设备为Ablatherm HIFU设备（EDAP SA，法国里昂）。
结果：患者平均72岁，中位前列腺体积30cc。中位Gleason分数为6分，中位PSA为7ng/ml，术前六点活检阳性标本中位值为2个。平均手术时间2小时48分，包括切除和HIFU。平均HIFU次数616次。术后第二天拔除尿管。中位住院时间3天。仅小部分患者有并发症。平均20个月的随访，86%患者HIFU后活检阴性，中位PSA为0.9ng/ml。1年随访时，平均IPSS为8。至于性功能，73%治疗前有功能的患者报告保存了性功能。
结论：联合应用经尿道内镜切除或切开和HIFU减少了留置尿管时间并提高了治疗后排尿的质量而并未增加并发症率。

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[个人评论]联合应用HIFU和TURP的确可以解决原来HIFU留置尿管时间长，恢复时间长的问题，不过个人认为这就失去了HIFU的本意----创伤小。
本人没有做过HIFU，只是个人浅见，望高手指点。