膀胱非尿路上皮性肿瘤的诊治(附46例报告)

目的:探讨膀胱非尿路上皮性肿瘤的诊断、治疗方法和预后。方法:回顾性分析2002年1月～2010年12月收治的46例膀胱非尿路上皮性肿瘤患者的临床资料:男34例,女12例。年龄30～82岁,平均61.3岁。术前辅助检查主要包括B超、盆腔CT、膀胱镜加病理活检以及131I-MIBG。42例行手术治疗,4例放弃手术。结果:46例术前或术后病理检查诊断为膀胱鳞状细胞癌19例,膀胱腺癌18例(单纯性非脐尿管腺癌8例,脐尿管腺癌5例,转移性腺癌5例),膀胱小细胞癌4例,膀胱嗜铬细胞瘤5例。术后40例随访12～72个月,膀胱嗜铬细胞瘤5例均健在,膀胱鳞癌及腺癌各2例随访至14～26个月仍存活,其余患者平均存活时间13.2个月。结论:膀胱非尿路上皮恶性肿瘤恶性程度高,确诊时大多已是晚期,预后差。膀胱根治性切除术是除转移性癌和小细胞癌外的膀胱非尿路上皮性恶性肿瘤的推荐手术方案,小细胞癌以化疗为主,转移性癌以改善尿路症状为主,良性嗜铬细胞瘤以膀胱部分切除为主。

The diagnosis and treatment of non-urothelial bladder tumors(Report of 46 cases)

Objective:To investigate the diagnosis,treatments and prognosis of non-urothelial bladder tumor.Methods:Retrospective analysis of 46 cases of non-urothelial bladder tumor cases were carried out from January 2002 to December 2010 in our hospital,of whom 34 males and 12 females,aged 30 to 82 years,mean age 61.3 years old.The diagnostic methods included B-type ultrasound,pelvic CT scan,cystoscopy plus biopsies,and 131I-MIBG.42 patients underwent surgical treatment,and 4 patients gave up surgery.Results:Preoperative or postoperative pathological diagnosis of bladder squamous cell carcinoma in 19 cases,bladder adenocarcinoma in 18 cases(simple non-urachal in 8 cases,urachal adenocarcinoma in 5 cases,metastatic adenocarcinoma,in 5 cases),bladder small cell carcinoma in 4 cases,bladder pheochromocytoma in 5 cases.40 cases were followed up from 12 to 72 months,5 bladder pheochromocytoma cases were alive,2 bladder adenocarcinoma patients and 2 bladder squamous cell carcinoma cases were followed up to 14-26 months and were still alive,and the average survival time of other patients was 13.2 months.Conclusions:Non-urothelial bladder tumor was highly malignant tumor and most of them with clinical symptoms were advanced cancer and had poor prognosis.In addition to metastatic cancer and small cell carcinoma of bladder,radical resection of bladder was recommended for non-urothelial bladder cancer.Chemotherapy was a common therapeutic method for small cell carcinoma,partial cystectomy was a common operation for benign pheochromocytoma,and improving urinary tract symptoms for metastatic cancer was only a palliative treatment.