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Declan G. Murphy教授:保留神经的前列腺癌根治术精析

Published at: 2015年第1卷第S1期

徐文珂 , 周丽桃
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编者按:2017年12月9日至10日,由中国抗癌协会泌尿男生殖系统肿瘤专业委员会、上海市抗癌协会联合主办,复旦大学附属肿瘤医院承办的中国抗癌协会泌尿男生殖系统肿瘤专委会2017年会暨第七届上海泌尿肿瘤国际论坛圆满召开。此次会议众星云集,为大家带来了一场聚焦泌尿男生殖系统肿瘤领域的学术盛宴。我们有幸采访到了此次会议特邀讲者Declan G. Murphy教授,他针对“保留神经的前列腺癌根治术——解剖精析”这一个主题为我们进行了讲解(图1)。

图1. Declan G. Murphy教授

人物聚焦:Declan G. Murphy

Declan Murphy moved to Melbourne, Australia in January 2010 to take up appointments as consultant urologist at the Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, and Director of Outcomes Research at the Australian Prostate Cancer Research Centre. He is honorary clinical associate professor at the Department of Surgery, University of Melbourne, St Vincent’s Hospital and director of robotic surgery at the Peter MacCallum Cancer Centre. He had previously been consultant urologist at Guys & St Thomas’ NHS Foundation Trust in London.

Originally from Galway in the West of Ireland, Declan completed his basic surgical training in Dublin before moving to London to continue higher specialist training on the South Thames rotation of the London Deanery. He is trained in all aspects of open and endoscopic urology and has a particular interest in laparoscopic and robotic-assisted surgery, particularly for the management of prostate, renal and bladder cancer. Following completion of his specialist training at Guy’s and having been awarded the FRCS Urol in 2006, he spent a year in Melbourne completing a Fellowship in Laparoscopic & Robotic Urology under the supervision of professor Tony Costello. He was awarded the FRACS in the specialty of urology by the Royal Australasian College of Surgeons in 2011. Declan has a strong academic background and has published extensively in the field of minimally-invasive urology for the management of prostate, renal and bladder cancer. He is associate editor of the British Journal of Urology International, consulting editor of European Urology, on the Expert Advisory Board of Nature Reviews Urology and the editorial board of the Journal of Robotic Surgery, and is a regular reviewer for The Journal of Urology, Journal of Endourology, Journal of Sexual Medicine, Cancer and many others. With professor Tony Costello, he is co-director of the Melbourne Uro-Oncology Training Program based at Royal Melbourne Hospital, the Peter MacCallum Cancer Centre and Epworth Hospital, Richmond. Since 2010, he has convened the urology program at the Australasian Prostate Cancer Conference, one of the world’s leading prostate cancer educational events.

采访摘要

作为本次会议的特邀讲者,Murphy教授就“保留神经的前列腺癌根治术——解剖精析”这一主题为我们进行了精彩的讲解。

什么样的患者适用保留神经的前列腺癌根治术?这是目前讨论非常热烈的话题。Murphy教授表示,他们希望能做到的不仅是对癌症有好的治疗效果、保留泌尿系统功能,更重要的是尽量保留性功能,这也是神经保留术兴起的缘由。至于哪一类患者适用于神经保留术,Murphy教授认为,患者是否适合手术需要从患者和疾病两方面进行评估。患者方面,考虑的第一点是其性活跃程度,第二点是年龄,在这两点的考虑上,必须非常谨慎和明智,以免给患者造成不必要的负担。

Murphy教授还为我们介绍了前列腺癌根治术的最新进展以及这项技术未来的发展方向。他谈到,目前中国有很多经验丰富的外科医生进行开放的前列腺癌根治术,腹腔镜根治术以及越来越多的机器人辅助前列腺癌切除术。他提到,在进行这些手术时,医生最需要具备的条件是对神经的解剖学原理有足够的了解。他认为不管手术具体方法是什么,医生都需要非常详细地了解解剖学知识并将它们应用到细致的外科手术中。在许多西方国家,机器人辅助手术越来越受欢迎,但非常大一部分的手术经验还是来自中国。

Murphy教授在机器人手术领域是世界公认的引领者,但众所周知,Murphy教授在最早时是专注于腹腔镜手术的,是什么促使他探索机器人手术领域呢?当笔者提到这个问题时,他表示十分愿意分享这一段经历。当时Murphy教授在伦敦的一家医院进行泌尿外科手术的培训,2004年时,医院采购了第一台达芬奇机器人。他们是英国第一家拥有这台机器的医院。Murphy教授说,当时这台机器就在他隔壁的手术室。但是当时的普遍看法是这台机器价格昂贵,以后不会大范围普及,所以他依旧是专注于腹腔镜手术。随着技术的发展,当他逐渐去接触机器人手术后,他发现大量数据表明,通过达芬奇机器人完成的手术效果都非常好,机器人的确是一个很棒的工具,这使他逐渐改变了主意,从腹腔镜手术领域慢慢转换到了机器人手术领域。他表示,虽然机器人手术成本很高,但这一点在未来的一段时间里一定会得到改善,以后也能给患者带来更大的受益。

另外,据Murphy教授介绍,PSMA-PET CT能够更准确地检测出接受过前列腺癌手术或放射疗法的患者的肿瘤复发情况。当传统的检测方法不适用时,PSMA-PET CT可用于检测非常小的肿瘤沉积,所以PSMA-PET CT在这一点上是优于传统影像技术的。虽然PSMA-PET CT价格昂贵且较难购买,但是目前在一些城市,这项技术已经逐步投入使用。通过一定的努力,相信以后这项技术可以普遍应用,且能给患者带来广大益处。

Murphy教授还提到,PSMA-PET CT不仅仅可以用于诊断,还可以用于治疗。因为PSMA-PET CT的另一个令人激动的应用是它不仅仅能使用PET示踪剂发现疾病,同时也可以通过标记PSMA分子来治疗疾病。Murphy教授列举了一些他们正在进行的前瞻性研究的例子,如通过使用核素镥-177结合PSMA来治疗晚期转移性疾病患者。Murphy教授认为我们现在已逐渐进入了一个PSMA-PET CT技术应用非常出色的时代。

Murphy教授也为我们分析了这PET-CT与PSMA-PET CT技术各自的优劣势,Murphy教授认为最好的使用办法是将PET和CT结合起来,而PSMA-PET CT的最佳使用方式还是与PET-CT扫描仪相结合。而关于将PET与MRI结合应用的技术,他表示,他们虽然对这一点很感兴趣但是现在已经决定不投资PET-MRI了,因为这一技术的成本目前十分昂贵,他认为这一技术不会成为一个标准,而是作为一种研究工具被大家使用。

采访的最后我们邀请Murphy教授给青年医生送上一些寄语。他提到,对于那些想要在探索前列腺癌治疗方式中工作的医生来说,非常重要的一点是不要过分沉迷于手术技术,年轻医生要想在前列腺癌手术中有所发展,不能只关注优秀的机器人手术视频,而是要了解关于前列腺癌的一切生物学知识,因为作为一名医生,要想真正照顾好患者,光靠提升手术技术是远远不够的。

欲知更多精彩内容,欢迎观看下方采访视频。

采访问题

1. As a distinguished invited speaker for this annual meeting, would you like to summarize some main points of your topics to share with us?

2. In the diagnosis of prostate cancer, PET-CT and PSMA-PET CT, which one is better in your opinion, and what are the differences between them?

3. What kind of patients are suitable for nerve-sparing radical prostatectomy? (or what are the indications for nerve-sparing radical prostatectomy?)

4. What are the latest advances in radical prostatectomy, and how do you see the future of it?

5. You are a world-recognized leader in the field of robotic surgery, however, as we know, you used to focus more on laparoscopic surgery, what motivate you to learn the robotic surgery?

6. In radical prostatectomy, compared to traditional surgery, what are the common complications of robotic surgery? From your rich experience, how to avoid or limit these complications?

7. What’s your advice to younger physicians who would like to engage in this field (of prostate surgery)?


采写编辑:徐文珂、周丽桃,AME Publishing Company

视频编辑:麦雪芳,AME Publishing Company

责任编辑:许梦杨,AME Publishing Company

学术审核:张开平,AME Publishing Company

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