原发性输尿管恶性肿瘤（附34例报告）

为探讨原发性输尿管肿瘤的诊断方法和治疗效果，报道原发性输尿管恶性肿瘤３４例，其中移行细胞癌３１例，鳞癌２例，平滑肌肉瘤１例。男性２３例，女性１１例；年龄２５～８４岁，平均５４．５岁。１７例行患侧肾及输尿管全切及膀胱袖状切除术，３例行患侧肾及输尿管部分切除术，４例行输尿管节段切除术，１例行患侧肾输尿管及膀胱全切术。２６例获随访，死亡８例。认为尿路造影、膀胱镜检查是最重要的诊断手段，患侧肾输尿管全切及膀胱袖状切除术是首选术式，本组５例存活５年以上者均为采取此术式患者。     

胃代膀胱术24例报告

１９９１年５月－１９９４年１２月行胃代替膀胱术２４例，其中膀胱移行细胞癌２１例，结核性膀胱挛缩２例，膀胱平滑机肉瘤１例。肿瘤患者行全膀胱切除术，１９例行胃膀胱成形术，３例行可控性低压胃膀胱术，结核性膀胱挛缩２例行胃扩大膀胱术，随访４－３９个月，３例死于肿瘤转移，２１例饮食健康良好，恢复工作。１８例经尿道排尿，每２４小时５－１０次，每次尿量３５０－８００ｍｌ，剩余尿０－３０ｍｌ，２例超过５０ｍｌ。肾     

脐尿管腺癌(附12例报告)

目的　提高脐尿管腺癌的诊治效果。　方法　回顾性总结１９７８ ～１９９７ 年收治１２ 例脐尿管腺癌的诊治结果。　结果　脐尿管腺癌占同期收治膀胱癌６８８ 例的１ ．７ ％ ，膀胱腺癌的３８ ．７ ％ 。血尿为最常见的临床症状，膀胱镜检见膀胱顶部肿瘤直径小于 Ｂ 超或 Ｃ Ｔ 扫描结果。７ 例行扩大性膀胱部分切除，无１ 例局部复发，５ 例行膀胱部分切除术，其中４ 例复发。５ 年生存率３３ ％ 。２ 例肺转移患者经放疗＋ 化疗后分别生存２８ 个月和６０ 个月。　结论　扩大性膀胱部分切除术可作为脐尿管腺癌的主要手术方式，对复发、转移病例应积极采取综合治疗。     

泌尿生殖系平滑肌肿瘤25例临床分析

目的：探讨泌尿生殖系平滑肌肿瘤的临床表现为诊治方案。方法：对１９８０年以来收治的泌尿生殖系平滑肌肿瘤２５例进行分析，其中平滑肌瘤２１例，平滑肌肉瘤４例，分别位于肾、输尿管、膀胱、前列腺、尿道、精索及附睾。２１例平滑肌瘤均行肿瘤切除术，４例平滑肌肉瘤，３例行肿切除术，１例行活检术。结果：随访２￣８年，平滑肌瘤术后未发现复发性维生素 ４例平滑肌肉瘤中的应急３例术后生存１．４￣３．２年后死亡，１例后，４     

膀胱非移行细胞恶性肿瘤（附128例分析）

膀胱非移行细胞恶性肿瘤较为少见，报告１９５１年１月～１９９６年３月收治的膀胱非移行细胞恶性肿瘤１２８例，占同期１７５６例膀胱肿瘤的７３％。所有病例均经病理学证实，其中鳞癌、腺癌及其与移行细胞混合癌占８４４％。分析发现，此类肿瘤的临床表现以血尿和膀胱刺激症为主，Ｔ３期以上者占７０４％，治疗上以膀胱全切及部分切除术为主，１、３及５年生存率为７８６％、４７３％及２９８％，预后与肿瘤分期关系明显。     

肾盂恶性肿瘤（附31例报告）

报告３１例肾盂恶性肿瘤，其中移行上皮细胞癌２７例，移行上皮及鳞状上皮混合性癌３例，腺癌１例。静脉尿路造影（ＩＶＵ）和ＣＴ为主要诊断方法。肾、输尿管全长及膀胱袖状切除可预防肾盂肿瘤的种植。术后定期复查膀胱镜和灌注化疗药物十分必要。     

根治性切除治疗上尿路移行上皮癌

采用经腹行肾筋膜外肾、输尿管全长及膀胱壁袖状切除加腹膜后清扫的根治性切除术治疗上尿路移行细胞癌２５例，术后５～１２年存活２２例；术后３年内死亡３例，其中１例与原发病无关，另２例为继发膀胱癌或对侧肾盂癌，但无腹膜后局部复发的临床证据。认为本术的切除范围有利于预防肿瘤的局部复发。     

保留肾组织手术治疗肾癌

１９８９年１２月～１９９７年４月行保留肾组织手术治疗肾癌１４例，其中双侧肾癌５例，对侧肾有病变或潜在功能受损的肾癌３例，对侧肾正常肾癌６例。肿瘤平均直径２９ｃｍ，病理分期为Ｔ１、Ｔ２。１４例中５例行剜出术，９例行肾部分切除术。本组术后无外科并发症，平均随访４６６个月，无瘤存活１２例，无局部复发。存活时间超过７年者２例，５年者４例，３年者１例，１年者２例，半年者３例。保留肾组织手术是早期局限性肾癌的有效治疗方法，可用于对侧肾正常、肿瘤体积较小的早期肾癌的治疗     

原癌基因C－erb B－2在肾盂输尿管癌中表达的临床意义

为了了解原癌基因ＣｅｒｂＢ－２在肾盂输尿管癌中表达的临床意义，采用免疫组化Ｓ－Ｐ法对４６例肾盂输尿管癌Ｃ－ｅｒｂＢ－２蛋白表达与病理分期、细胞分级、复发与预后的关系进行研究。结果显示：肾盂输尿管癌中Ｃ－ｅｒｂＢ－２蛋白表达阳性率为３４．８％，Ｔ＿３＋Ｔ＿４Ｃ－ｅｒｂＢ－２表达阳性率高于Ｔ＿１＋Ｔ＿２，Ｐ＜０．０１；Ｇ＿３ＣｅｒｂＢ－２表达阳性率高于Ｇ＿２，Ｐ＜０．０５，Ｇ＿１Ｃ－ｅｒｂＢ－２染色均为阴性。Ｃ－ｅｒｂＢ－２表达阳性者同时发生尿路上皮多器官癌占３１．３％，表达阴性者同时发生尿路上皮多器官癌占１３．３％。Ｃ－ｅｒｂＢ－２表达阳性者术后膀胱癌再发率为６２．５％，高于表达阴性者２６．７％，Ｐ＜０．０５。Ｃ－ｅｒｂＢ－２表达阳性者５年生存率为３０．８％，表达阴性者为８１．３％，Ｐ＜０．０５。提示Ｃ－ｅｒｂＢ－２表达阳性者肿瘤有多器官发病倾向，肿瘤更具侵袭和转移；其表达与肿瘤病理分期、细胞分级有关，可能是判断肾盂输尿管癌预后的一个重要指标。     

腹腔镜及开放根治性肾输尿管膀胱切除术治疗上尿路肿瘤合并膀胱癌8例报告

目的探讨腹腔镜和开放根治性肾输尿管膀胱切除术治疗上尿路肿瘤合并膀胱癌患者的可行性和安全性。方法收集我院2004年6月至2009年3月期间收治的8例单侧上尿路肿瘤并浸润性膀胱癌行根治性肾输尿管膀胱切除术及尿流改道手术患者的临床资料并进行随访分析。结果本组8例。男7例,女1例,平均年龄56岁。术前经膀胱镜、输尿管镜、B超和CT等检查证实为单侧上尿路肿瘤并浸润性膀胱癌,其中4例左肾盂癌和2例右肾盂癌合并膀胱癌,2例为左输尿管癌合并膀胱癌。2例行腹腔镜肾输尿管膀胱切除术及回肠膀胱术,平均手术时间470min,术中平均出血量275ml,均无输血,术后肠功能恢复时间为2d,下床活动时间为4d。6例患者行开放肾输尿管膀胱全切除术,其中4例行回肠膀胱术,另2例行输尿管造口术,平均手术时间366min,平均出血量767ml,平均输血量485ml,术后肠功能恢复时间为3.3d,下床活动时间平均为6.7d。8例患者术后均未出现并发症。术后病理结果 7例为尿路上皮癌,上尿路肿瘤分期分级为T2～4N0～1M0G2,膀胱癌为T2～3N0M0G3,另1例为左肾盂鳞癌T4N1M0合并膀胱鳞癌T3N0M0。术后平均随访24.6个月,鳞癌患者术后18个月因肿瘤广泛转移死亡,余7例患者无瘤生存至今。结论单侧上尿路肿瘤合并膀胱癌可行Ⅰ期根治性肾输尿管膀胱切除术,腹腔镜下行该手术是可行及安全的,较开放手术创伤小,出血少,恢复快。     

Outcome of the treatment of invasive non-transitional cell carcinoma

BACKGROUND: We evaluated the treatment outcomes of non-transitional cell carcinoma (non-TCC) cases after radical cystectomy. METHODS: Radical cystectomy was performed in 259 invasive bladder cancer patients in our department and of these, 59 (22.7%) were non-TCC. Primary squamous cell carcinomas (SCC), adenocarcinomas and undifferentiated cancers (UC) were grouped as non-TCC of the bladder. Of the 59 non-TCC; 32 SCC, 20 UC, five adenocarcinoma and two sarcomatoid tumor cases were demonstrated. RESULTS: The 5-year disease-specific survival rate of TCC and non-TCC cases were 48.9 and 28.2%, respectively (P = 0.0016). The 5-year disease-specific survival rates of SCC and UC were 25.1 and 23.4%, respectively. The median survival time of SCC, UC and adenocarcinoma cases were 19, 12 and 6 months, respectively (P = 0.4579). The disease-specific survival rates of TCC and non-TCC cases at stage pT2NoMo were 79.1 and 27.2%, respectively (P = 0.0000). The median survival time of SCC, UC and adenocarcinoma cases were 19, 12 and 13.3 months, respectively, for the same stage. The survival time of TCC, SCC and UC cases at stage pT3NoMo were 23, 26 and 45 months, respectively (P = 0.2307). The median survival time at stages pT2-3N1Mo for the same groups were 18, 16 and 11 months, respectively (P = 0.0939). CONCLUSION: The study presented here demonstrates that both TCC and non-TCC cases have poor survival rates in locally advanced disease and that at the pT2NoMo stage the prognosis of non-TCC cases is poor when compared with TCC cases.     

Clinical outcomes following radical cystectomy for primary nontransitional cell carcinoma of the bladder compared to transitional cell carcinoma of the bladder

PURPOSE: The effect of bladder cancer histological subtypes other than transitional cell carcinoma (nonTCC) on clinical outcomes remains uncertain. We conducted a multi-institutional retrospective study of patients with bladder cancer treated with radical cystectomy to assess the impact of nonTCC histology on bladder cancer specific outcomes. MATERIALS AND METHODS: A total of 955 consecutive patients underwent radical cystectomy with bilateral pelvic lymphadenectomy for bladder cancer at 3 academic institutions. TCC was present in the radical cystectomy specimen in 888 patients (93%). NonTCC histology was present in 67 patients (7%), including squamous cell carcinoma in 26, adenocarcinoma in 13, small cell carcinoma in 10 and other nonTCC subtypes (ie spindle cell carcinoma, carcinosarcoma and undifferentiated carcinoma) in 18. For patients alive at last followup median followup was 39 and 23 months for patients with TCC and nonTCC histologies, respectively. Bladder cancer specific progression and survival were assessed using Kaplan-Meier and multivariate Cox proportional hazards analyses. RESULTS: Bladder cancer specific progression and mortality did not differ significantly between patients with SCC and TCC histologies. Patients with nonTCC and nonSCC bladder cancer were at significantly increased risk for progression and death compared to patients with TCC or SCC (p <0.001). This association remained statistically significant in patients with organ confined disease (stage pT2 or lower) and patients with nonorgan confined disease (stage pT3 or higher) (p <0.001). In a multivariate analysis nonTCC and nonSCC histology was associated with an increased risk of bladder cancer progression and death (OR 2.272 and 2.585, respectively, p <0.001), even after adjusting for final pathological stage, lymph node status, lymphovascular invasion and neoadjuvant or adjuvant treatments. CONCLUSIONS: NonTCC and nonSCC histological subtype is an independent predictor of bladder cancer progression and mortality in patients undergoing radical cystectomy for bladder cancer. Patients with bladder TCC and SCC share similar stage specific clinical outcomes.     

A case of lung metastases of bladder cancer in which thoracotomy was performed following M-VAC therapy

A case of lung metastases of bladder cancer in which thoracotomy was performed following M-VAC is presented. A fifty-nine-year-old man underwent radical cystectomy and ileal conduit diversion for bladder cancer. Pathological diagnosis was TCC greater than AC much greater than SCC. After nine months, he was admitted because of lung metastases. Three courses of M-VAC therapy brought partial remission. A thoracotomy was performed on residual lung metastasis. Pathological diagnosis was AC much greater than TCC greater than SCC. Because M-VAC therapy has limited antitumor activity against mixed histological bladder cancer, we recommend not only M-VAC therapy but also surgical resection for the metastatic tumor the primary site of which has nontransitional components.     

膀胱小细胞癌的诊断与治疗(附6例报告)

目的：探讨膀胱小细胞癌的临床特点及诊治疗效。方法：对6例膀胱小细胞癌患者的临床资料进行回顾性分析。结果：6例患者，男4例，女2例，平均年龄63岁（51～71岁）。肿瘤分期T2N0M02例，T3N0M0 1例，T4N0M0 2例，T4N2M1 1例。肿瘤电切加化疗1例，根治性膀胱全切2例，姑息膀胱切除加化疗2例，肿瘤电切、髂动脉栓塞及全身化疗1例。4例死于肿瘤复发或转移，平均存活时间7个月（2～15个月），2例分别随访18个月及21个月仍存活。结论：膀胱小细胞癌预后差，治疗应以手术结合放化疗。     

A case of transitional cell carcinoma with squamous differentiation which developed squamous cell carcinoma in situ in the clinical course

In August 2000, a 62-year-old woman presented to another municipal hospital with macroscopic Transurethral resection of bladder tumor (TUR-Bt) was performed. The pathological hematuria. diagnosis was transitional cell carcinoma (TCC), G2 > squamous cell carcinoma (SCC). TUR-Bt repeated in July 2003 indicated recurrence. The pathological diagnosis was TCC, G2. She was referred to our hospital in August 2003 because she desired bladder preservation. After cystoscopy and random biopsy, pathological diagnosis was TCC with squamous differentiation, G1-G2, pTis. She received 7 weekly intravesical bacillus Calmette-Guerin (BCG) instillations. In April 2004, TUR-Bt was repeated and multiple recurrences were found. The pathological diagnosis was TCC with squamous differentiation, G1-G2, pTa. She received 10 weekly intravesical Pirarubicin hydrochroride instillations. In August cystoscopy and random biopsy were performed for evaluation of the intavesical instillation treatment. Pathological diagnosis was atypical squamous cells. In November, cystoscopy revealed recurrence of a bladder tumor. After admission, a small papillary tumor and multiple flat lesion biopsies demonstrated SCC without obvious invasion. The patient underwent cystectomy. There were widespread areas of full thickness squamous atypia. Most of the bladder did not show appearance of typical TCC, but the final pathological diagnosis was TCC because the case developed from TCC and could not be diagnosed as pure SCC. The diagnosis of SCC in situ of bladder is difficult, and this may contribute to its rarity.     

Subsequent upper urothelial cancer following bladder tumor

A total of 110 patients were treated with primary transitional cell carcinoma (TCC) of the urinary bladder from 1990 to 2000. During the follow-up period, which was for at least two years, four patients (3.6 percent) had subsequent upper urothelial cancer at an average of 61.5 months after initial treatment of the bladder tumor. Two of the four patients received transurethral resection several times, and the remaining two patients underwent radical cystectomy for the initial bladder tumor. The histopathological findings of subsequent upper urothelial cancer were almost the same as those for the initial bladder tumor. One patient had accompanying carcinoma in situ (CIS) and the other had adenocarcinoma with TCC. Since 1) high grade, 2) multiple, 3) recurrent and 4) occupational bladder tumors, 5) concomitant CIS, 6) vesicoureteral reflux and 7) tumor invasion of the intravesical ureters have been reported to be risk factors for developing subsequent upper urothelial cancer, patients with bladder tumors who have these risk factors should be followed-up closely.     

原发性膀胱腺癌的诊断与治疗(附13例报告)

目的:提高原发性膀胱腺癌的诊治水平。方法:回顾性分析2000~2006年收治的13例原发性膀胱腺癌患者诊治资料,并复习相关文献。结果:9例患者接受了膀胱全切加尿流改道,3例行部分膀胱切除术,1例行TURBT术。接受保留膀胱手术的患者均于术后6个月~1年复发,其中2例再行膀胱全切加尿流改道,随访未见肿瘤复发,另外2例因肿瘤转移至肺脏死亡;9例接受膀胱全切加尿流改道的患者,2例死于全身转移,失访1例,余6例随访至今未见肿瘤复发。结论:膀胱腺癌恶性程度高、转移早,因此,应采取更积极的手术态度,早期行膀胱癌根治性切除,术后辅助放疗有助于减少肿瘤复发。     

Long-term follow-up of ureteral stump tumors after nephrectomy for benign renal disease

OBJECTIVE: The occurrence of primary carcinoma of the ureteral stump after nephrectomy is rare. In this study, we evaluated the clinical characteristics of ureteral stump tumors after nephrectomy for benign renal disease. METHODS: During a 16-year period, 318 consecutive patients underwent simple nephrectomy for benign renal disease (216 cases) or for donation (102 cases). Eight of these 318 patients diagnosed as having an ureteral stump tumor were treated by ipsilateral ureterectomy with cuff excision of the bladder. Pathologic findings, tumor stages, and clinical characteristics were analyzed. RESULTS: The eight ureteral stump tumors comprised; 6 transitional cell carcinomas (TCCs) and 2 squamous cell carcinomas (SCCs). The mean interval between nephrectomy and ureteral stump tumor diagnosis was 76.5 months. Six of the 8 patients had pyonephrosis and two renal tuberculosis as original renal diseases. Four of the 6 TCCs were stage T1 and 2 stage T2. There was no concomitant bladder tumor at stump tumor diagnosis. Hematuria was the major presenting symptom in 3 of the 8 patients and 4 patients were diagnosed by follow-up imaging study. Two of the 6 ureteral stump TCC patients developed bladder TCC during follow-up. The 5-year survival rate of patients with ureteral stump tumor was 37.5%. T1G1 TCC was associated with a better survival than T2 or G2 TCC. No ureteral stump tumor occurred in cases of donor nephrectomy. CONCLUSION: This study demonstrate, that long-term closed observation is needed to detect ureteral stump tumor, particularly in patients that have undergo nephrectomy for a long-standing inflammatory renal disease such as pyonephrosis or tuberculosis. Hematuria is a major presenting symptom of ureteral stump tumor. However, a follow-up imaging study is also important for ureteral stump tumor detection. The prognosis is poor in cases developing ureteral stump SCC, bladder tumor recurrence, or a high-grade ureteral tumor.     

Numerical chromosomal aberrations in muscle invasive squamous cell and transitional cell cancer of the urinary bladder: an alternative to classic prognostic indicators?

OBJECTIVES: To evaluate the prognostic value of chromosomal aberrations in muscle invasive bladder cancer, because they are of diagnostic and prognostic significance in superficial bladder cancer. METHODS: One hundred ninety patients, who underwent radical cystectomy because of squamous cell carcinoma (SCC) of the urinary bladder in 94 cases and transitional cell carcinoma (TCC) in 96 cases, were studied retrospectively. Numerical aberrations of chromosomes 7, 9, and 17, p53 positivity, histologic stage and grade, histologic tumor type, lymph node status, and the presence of bilharzial eggs were investigated as possible prognostic factors. RESULTS: Univariate analysis demonstrated the prognostic significance of all parameters analyzed, excluding chromosome 9. Multivariate analysis revealed only T category (P = 0.01095266), lymph node involvement (P = 0.00054877), and p53 positivity (P = 0.0316974) to be independent prognostic factors in muscle invasive SCC and TCC. CONCLUSIONS: Although chromosomal aberrations are associated with progression-free survival, they are not independent prognostic factors and give the clinician no additional information on patients with muscle invasive bladder cancer.     

Surgical Treatment Results of Invasive Non-Transitional Cell Tumours of the Bladder

Although the majority of bladder cancers are transitional cell carcinomas (TCC), non-transitional cell tumours (non-TCT) have significant importance because of their aggressive clinical course. We evaluated the treatment results of invasive transitional and non-transitional bladder tumours treated in our department. Non-transitional cell tumours were demonstrated in 51 (9.6%) of 527 bladder cancer cases from 1992 to 1998 in our department. Radical cystectomy was performed in 177 invasive bladder cancer patients and of these 47 (26.5%) had non-transitional cell tumours. The majority of patients (92.15%) with non-transitional cell tumours of the bladder had invasive disease at the time of diagnosis. The distribution of non-transitional cell tumours was: 24 (51%) squamous cell carcinoma (SCC), 15 (31.7%) undifferentiated carcinoma (UC), 4 (8.5%) adenocarcinoma and 4 (8.5%) sarcoma. Overall 12 and 42 months disease specific survival rates for TCC patients were 69.37% and 47.22%, respectively, whereas overall 12 months survival rate for non-TCT patients was 47.61%. The survival rates after radical cystectomy for SCC, UC, adenocarcinoma and sarcoma were 35.8%, 41.5%, 37.5% and 75%, respectively. In the literature, the incidence of non-transitional tumours is 5%. However, in our department, we observed an incidence of 26.5% between 1992 and 1998. We also arrived at the conclusion that non-transitional tumours of the bladder tend to be more aggressive than invasive urothelial tumours and in most patients invasive disease was also present at the time of diagnosis. Early diagnosis and radical cystectomy are the most important factors that influence the survival in cases of invasive non-transitional cell tumours of the bladder.