膀胱非尿路上皮癌的诊断与治疗

目的探讨膀胱非尿路上皮癌的发病特点,总结其诊治经验。方法回顾分析2001年1月至2009年12月收治的59例膀胱非尿路上皮癌的临床资料。其中男37例,女22例,平均年龄72.6岁;临床主要表现为无痛性肉眼血尿和膀胱刺激症状;辅助检查包括B超、盆腔CT及膀胱镜检＋活检。另选同期膀胱尿路上皮癌51例作为对照。比较两组患者围手术期治疗,术后1、3和5年生存率等差异。结果 59例膀胱非尿路上皮癌患者,术后病理检查证实膀胱腺癌13例、膀胱鳞癌10例、膀胱小细胞癌5例、膀胱平滑肌肉瘤2例、副神经节瘤4例和混合癌肿25例。其中行全膀胱切除术41例,膀胱部分切除术6例,经尿道膀胱肿瘤电切术（TUBRT）12例。术前新辅助治疗4例,术后辅助放疗14例,术后辅助化疗35例。有效随访53例,术后1、3和5年生存率分别为83.1%、54.7%和28.3%。51例膀胱尿路上皮癌术后均经病理证实诊断,其中行全膀胱切除术12例,膀胱部分切除术3例,TUBRT36例。术后成功随访43例,术后1、3和5年生存率分别为81.8%、76.7%和72.7%。结论膀胱非尿路上皮癌临床少见,恶性程度较高,预后较差。根治性膀胱全切除术是首选手术方法,结合不同肿瘤类型的病理特点,辅助或新辅助放、化疗可望提高疗效。

Diagnosis and treatments of non-urothelial bladder cancer

Objective To evaluate the diagnosis and treatments of non-urothelial bladder cancer,and find out the incident tendency and characteristics.Methods The clinical data of 59 cases of non-urothelial carcinoma of the bladder from January 2001 to December 2009 of our hospital were retrospectively analyzed.37 patients were male and 22 were female,with a mean age of 72.6 years.The main clinical manifestation included painless gross hematuria,irritative bladder symptoms,dysuria etc.The diagnostic methods included ultrasound,pelvic CT scan and cystoscopy plus biopsies etc.51 cases of bladder urothelial carcinoma were contrastively analyzed.All patients underwent operations and the 1,3 and 5-year of survival rates were obtained.Results Among the 59 cases of bladder non-urothelial carcinoma,13 cases were adenocarcinoma,10 cases were squamous carcinoma,5 cases were small cell carcinoma,4 cases were paraganglioma,2 cases were leiomyosarcoma and 25 cases were mixed tumors.41 cases underwent radical cystectomy,6 cases underwent partial cystectomy and 12 cases were underwent transurethral resection of bladder tumor（TURBT）.4 cases underwent preoperative neoadjuvant thearapy,14 cases underwent postoperative radiotherapy and 35 cases underwent postoperative adjuvant chemotherapy.53 patients were followed up for 5 months to 8 years.The 1,3 and 5-year of survival rates were 83.1%,54.7% and 28.3% respectively.Among the 53 cases of bladder urothelial carcinoma,12 cases underwent radical cystectomy,3 cases underwent partial cystectomy and 36 cases underwent TURBT.The 1,3 and 5-year of survival rate were 81.8%,76.7% and 72.7% respectively.Conclusions The non-urothelial bladder cancer is uncommon in clinical practice,with a higher degree of malignancy and poor prognosis.The radical cystectomy is the preferred choice of management and the adjuvant or neoadjuvant thearapy is useful for the curative effect.