Оптимизация хирургического лечения больных локализованным раком предстательной железы
У некоторых пациентов, которые подверглись РПЭ, последующее морфологическое исследование выявляет экстрапростатический процесс. Часть этих пациентов не может быть излечена только с помощью одной РПЭ. Не обнаруженная предварительно экстрапростатическая экстензия (ЭЭ), может привести к неполному её иссечению, появлению позитивного хирургического края (ХК) и повышает риск рецидивирования… Читать ещё >
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- Список сокращений
Глава 1. МЕТОДЫ ДИАГНОСТИКИ, ЛЕЧЕНИЯ И ПРОГНОЗИРОВАНИЯ ИСХОДОВ РАДИКАЛЬНОГО ЛЕЧЕНИЯ ЛОКАЛИЗОВАННЫХ ФОРМ РАКА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ (ОБЗОР ЛИТЕРАТУРЫ)
1.1. Роль простатического специфического антигена в диагностике и раннем стадировании рака предстательной железы.
1.2. Трансректальное ультразвуковое исследование и мультифо-кальная биопсия в диагностике рака предстательной железы.
1.3. Роль магнитно-резонансного исследования, компьютерной томографии и сцинтиграфии в диагностике и стадировании рака предстательной железы.
1.4. Методы лечения локализованного рака предстательной железы.
1.4.1. Выжидательная тактика — динамическое наблюдение.
1.4.2. Наружная лучевая терапия как метод радикального лечения рака предстательной железы.
1.4.3. Брахитерапия как самостоятельный метод радикального лечения.
1.4.4. Криохирургия рака предстательной железы.
1.4.5. Позадилонная радикальная простатэктомия.
1.4.5.1. Нервосохраняющая техника радикальной проста-тэктомии.
1.4.5.2. Лапароскопическая радикальная простатэктомия.
1.4.5.3. Промежностная техника операции.
1.4.6. Роль хирургического лечения рака предстательной железы в стадии Т3.
1.4.7. Прогнозирование вовлечения лимфатических узлов у пациентов с клинически локализованным раком предстательной железы и целесообразность лимфаденэктомии.
1.4.8. Прогностические факторы и их влияние на послеоперационные исходы.
1.4.8.1. Уровень сывороточного простатического специфического антигена.
1.4.8.2. Объем опухоли и число позитивных биопсийных столбиков.
1.4.8.3. Приготовление патоморфологических образцов и шкала Глисона.
1.4.8.4. Периневральная инвазия.
1.4.8.5. Позитивный хирургический край как неблагоприятный морфологический фактор.
1.4.8.6. Экстрапростатическая экстензия в прогнозировании исходов после РПЭ.
1.4.8.7. Роль иных прогностических факторов в стадиро-вании злокачественного процесса.
1.4.9. Различия в хирургической технике, влияющие на послеоперационные морфологические результаты и безрецидивную выживаемость.
1.4.10. Осложнения позадилонной радикальной простатэкто-мии.
1.4.10.1. Эректильная дисфункция при позадилонной радикальной простатэктомии.
1.4.10.2. Недержание мочи после радикальной простатэктомии.
1.4.11. Оценка и лечение биохимического рецидива после радикальной простатэктомии.
1.4.12. Неоадъювантная терапия рака предстательной железы.
Глава 2. МАТЕРИАЛЫ И МЕТОДЫ ИССЛЕДОВАНИЯ.
2.1. Общая характеристика методов исследования.
2.2. Патоморфологическая обработка и интерпретация биопсийных материалов.
2.3. Обработка и оценка патоморфологического материала после радикальной простатэктомии.
2.4. Характеристика больных.
2.5. Планирование и статистический анализ результатов исследования.
Глава 3. ИСПОЛЬЗОВАНИЕ ПРЕДОПЕРАЦИОННЫХ ПРОГНОСТИЧЕСКИХ ФАКТОРОВ И ИХ КОМБИНАЦИЙ В ДИАГНОСТИКЕ И СТАДИРОВАНИИ РАКА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ.
3.1. Роль сывороточного прстатического специфического антигена в диагностике и стадировании рака предстательной железы.
3.2. Роль пальцевого ректального исследования в диагностике и стадировании рака предстательной железы.
3.3. Мультифокальная биопсия как основной метод диагностики локализованного рака предстательной железы.
3.4. Комбинация предоперационных параметров в прогнозировании патоморфологических находок и стадировании рака предстательной железы. Создание прогностических моделей.
Глава 4. ХИРУРГИЧЕСКАЯ ТЕХНИКА ПРИ ВЫПОЛНЕНИИ ПОЗА-ДИЛОННОЙ РАДИКАЛЬНОЙ ПРОСТАТЭКТОМИИ У БОЛЬНЫХ РАКОМ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ.
4.1.Перипростатическая анатомия.
4.2. Описание элементов хирургической техники.
4.3. Особенности хирургической техники, позволяющие избежать появления позитивных хирургических краев.
4.4. Роль и целесообразность выполнения тазовой лимфаденэкто-мии.
Глава 5. ГЕОМОРФОЛОГИЧЕСКИЕ ХАРАКТЕРИСТИКИ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ И ИХ ВЛИЯНИЕ НА СТАДИРОВАНИЕ ПРОЦЕССА И БЕЗРЕЦИДИВНУЮ ВЫЖИВАЕМОСТЬ.
5.1. Взаимосвязь объёма поражения предстательной железы с частотой и временем наступления биохимического рецидива.
5.2. Частота и локализация позитивного хирургического края и его роль в прогнозировании рецидива после радикальной простатэктомии.
5.3. Экстрапростатическая экстензия как самостоятельный прогностический фактор безрецидивной выживаемости.
5.4. Шкала Глисона в определении вероятности возникновения рецидива после радикальной простатэктомии.
5.5. Прогнозирование патологической стадии и его влияние на послеоперационное течение заболевания.
5.6. Другие морфологические факторы и их вклад в безрецидивную выживаемость.
5.6.1. Периневральная инвазия и её влияние на безрецидивную выживаемость.
5.6.2. Поражение лимфатических узлов и частота рецидивиро-вания после радикальной простатэктомии.
5.6.3. Вовлечение семенных пузырьков.
Глава 6. ХАРАКТЕРИСТИКА И ПРЕДСКАЗАНИЕ СЛУЧАЕВ БИОХИМИЧЕСКОЙ ПРОГРЕССИИ, СОЗДАНИЕ МОДЕЛИ ПРОГНОЗА РЕЦИДИВА ПОСЛЕ РАДИКАЛЬНОЙ ПРОСТАТЭКТОМИИ И ПРОГНОСТИЧЕСКИХ ГРУПП.
6.1. Роль сывороточного простатического специфического антигена в наблюдении за пациентами после радикальной простатэктомии.
6.2. Использование прогностических групп для предсказания вероятности рецидива.
6.3. Общие закономерности рецидивирования и создание модели прогноза рецидива после радикального оперативного лечения.
Глава 7. ПОСЛЕОПЕРАЦИОННОЕ ВЕДЕНИЕ И ОСЛОЖНЕНИЯ ПО-ЗАДИЛОННОЙ РАДИКАЛЬНОЙ ПРОСТАТЭКТОМИИ.
7.1. Послеоперационное ведение: сроки удаления катетера и околопузырных дренажей.
7.2. Интраоперационные осложнения и их профилактика.
7.2.1. Повреждения прямой кишки.
7.3. Ранние послеоперационные осложнения.
7.4. Поздние послеоперационные осложнения и их профилактика.
7.4.1.Стриктуры пузырно-уретрального анастомоза.
7.4.2. Недержание мочи.
7.4.3. Эректильная дисфункция после позадилонной радикальной простатэктомии.
7.4.4. Другие осложнения.
Глава 8. ИСПОЛЬЗОВАНИЕ НЕОАДЪЮВАНТНОЙ ХИМИОТЕРАПИИ ПРИ РАДИКАЛЬНОЙ ПРОСТАТЭКТОМИИ.
8.1. Методика применения доцетаксела и характеристика больных
8.2. Результаты лечения и их анализ.
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