膀胱肿瘤合并前列腺增生症的同期外科治疗

目的探讨同期手术治疗膀胱肿瘤合并前列腺增生(BPH)的效果。方法回顾性分析2000年1月至2010年1月收治的81例膀胱肿瘤合并前列腺增生患者,30例行膀胱肿瘤电切术+前列腺电切术(A组),26例行膀胱部分切除术+前列腺切除术(B组),25例行单纯膀胱肿瘤电切术(C组),比较组间肿瘤的复发时间、复发率、复发位置、复发数量以及前列腺窝处肿瘤种植率,综合评价临床同时切除前列腺及膀胱肿瘤的效果。结果所有患者随访3～48月,平均18.5月。A组11例复发,平均复发时间为11.5月,全部为异位复发,其中3例为单发肿瘤,8例为多发肿瘤,复发率为36.7%,其中6例为T1期,遂行膀胱肿瘤电切术,5例为T2b期,行膀胱部分切除术;B组9例复发,平均复发时间为8.6月,全部为异位复发,其中5例单发肿瘤,3例为多发肿瘤,复发率为34.6%,其中2例复发患者为T3a期,遂行膀胱根治性切除术,6例复发患者为T1期,遂行膀胱肿瘤电切术;C组6例复发,平均复发时间为10.3月,其中原位复发2例,4例为异位复发,其中3例单发,3例多发,复发率为24%,复发肿瘤2例分期为T1期,又行膀胱肿瘤电切术,4例为T2a期,遂行膀胱部分切除术;A、B两组间随访时间、复发时间、复发率及前列腺部尿道种植率差异均无显著性(均P>0.05),比较A、C两组间患者治疗情况,两组间随访时间、复发时间、复发率及前列腺部尿道种植率差异均无显著性(均P>0.05)。结论同期行经尿道膀胱肿瘤加前列腺电切术治疗膀胱癌合并前列腺增生是一种安全、有效的治疗方法,不增加前列腺窝种植的风险,对膀胱癌术后复发无影响。

Surgery treatment of bladder tumor with prostate hyperplasia in the same time

Objective To investigate the effect of simultaneous prostate electrocision in patients with bladder carcinoma electrocision.Methods The clinical data from 81 patients with bladder carcinoma complicated with prostatic hyperplasia in our hospital from January 2001 to January 2010 were retrospectively analyzed.Among the 81 patients,30 had simultaneously undergone TURBT and TURP,26 cases were given partial cystectomy and prostatectomy,the rest 25 only TURBT.The recurrence time and rate,recurrence place and amount,prostatictum or implantation rate were compared between the three groups.The effects of simultaneous prostate electrocision in patients with bladder carcinoma electrocision were comprehensively evaluated.Results All the patients were followed up 3-48 months（mean 18.5 months）,11 patients recurred in group A,the average time of recurrence was 11.5 months,among the 11 patients,all the patients recurred in other position in the bladder,including 3 cases of single tumor and 8 cases of multiple tumors.The recurrence rate of group A was 36.7%,of which 6 were in stage T1 and they were undergone TURBT,the left 5 patients in stage T2b were given partial bladder resection;9 patients recurred in group B,the average time of recurrence was 8.6 months,among the 8 patients,all the patients recurred in other position in the bladder,including 5 cases of single tumor and 3 cases of multiple tumors.The recurrence rate of group B was 34.6%,of which 2 were in stage T3a and they were undergone radical cystectomy,the left 6 patients in stage T1 were given TURBT;6 patients recurred in group C,the average time of recurrence was 10.3 months,among the 6 patients,4 patients recurred in other position in the bladder,the left 2 cases recurred in situ,including 3 cases of single tumor and 3 cases of multiple tumors.The recurrence rate of group C was 24%,of which 2 were in stage T1 and they were undergone TURBT,the left 4 patients in stage T2a were given partial bladder resection;No statistically significant differences were found between group A and B in terms of follow-up time,recurrence rate,recurrence in the prostatic urethra,and elapsed time to recurrence,so were groups A and C.ConclusionSimultaneous TURBT plus TURP is a safe and effective therapy without increasing the risk of tumor recurrence and implantation of prostatic fossa.