综合治疗膀胱混合癌的临床观察

目的 分析膀胱混合癌配合体部伽玛刀等综合治疗的疗效.方法 报告2003年7月至2013年8月本院收治的17例膀胱混合癌患者的临床资料,结合文献对该病的临床表现、诊断、治疗和加全身伽玛刀综合治疗以及预后情况进行讨论.结果 膀胱混合癌占同期362例膀胱恶性肿瘤的4.4％,移行、腺细胞混合癌5例,移行、鳞状细胞混合癌8例,移行、鳞状、腺细胞混合癌2例,鳞状、腺细胞混合癌2例.以膀胱刺激征和肉眼血尿为主要临床表现,治疗以膀胱全切和部分切除为主,术后辅助化疗或放疗,其1、3和5年的生存率分别为90.6％、52.8％和35.3％.结论 膀胱混合癌的恶性程度高,早期诊断和治疗是提高生存率的关键.全身伽玛刀配合手术及化疗等综合治疗有助于改善预后,提高生存率.     

膀胱鳞状细胞癌（附12例报告）

目的提高对膀胱鳞状细胞癌的诊治水平。方法回顾分析1980年1月至1999年7月收治的12例膀胱鳞状细胞癌临床资料,结合献进行讨论。结果12例中膀胱部分切除术6例,全膀胱切除术 尿流改道术4例,姑息性尿流改道术2例。随访1年生存率50％(6／12),5年生存率16．7％(2／12)。结论膀胱鳞状细胞癌浸润性强,恶性程度高,预后不良。早期诊断、严格掌握手术指征是提高膀胱鳞状细胞癌患5年生存率的有效措施。     

原发性肾盂输尿管癌的诊断与治疗（附45例报告）

目的：提高肾盂输尿管癌的诊治水平。方法：回顾性分析我院自2000年1月～2008年3月收治的45例原发性肾盂输尿管癌患者的临床资料。结果：临床表现有血尿40例,腰痛8例,体检发现肾积水1例。阳性率较高的检查有逆行尿路造影、CT、MRI和输尿管镜检查,阳性率分别为66．7％（8／12）、78．8％（26／33）、90．0％（9／10）和90．0％（9／10）。35例（87．5％）做了肾输尿管全长切除、膀胱袖状切除术。35人（77．8％）得到随访,10例在术后13（5～33）个月内14次发生膀胱肿瘤,1例输尿管癌术后3．5年发现对侧肾盂癌,14例死于癌转移,5年总体生存率为34．3％（12／35）。结论：对反复出现的肉眼血尿、腰痛和肾积水患者要考虑本病的可能,联合应用几种检查方法是提高诊断率的关键,肾输尿管全切、膀胱袖状切除术是主要治疗方法。     

82例阴茎鳞状细胞癌临床诊断与治疗

目的：提高阴茎鳞状细胞癌的诊断和治疗水平。方法：回顾性分析1980-2005年82例阴茎鳞状细胞癌患者临床资料,结合文献复习进行讨论。结果：77例病例行手术治疗,其中阴茎部分切除术64例,阴茎全切术13例。阴茎切除加髂腹股沟淋巴结清扫14例（腹股沟淋巴结均为阳性,髂淋巴结均为阴性）。放疗3例,化疗1例,放化疗联合治疗1例。71例患者随访1～10年,5例1年内死亡,17例2～5年内死亡,49例生存5年以上,占69％,其中34例生存10年,占48％,11例失访。结论：包茎、包皮过长是阴茎鳞状细胞癌的重要诱因;HPV感染可能与阴茎鳞状细胞癌发生有关。外科手术治疗是目前治疗阴茎鳞状细胞癌的有效方法;淋巴结清扫范围应采用由浅至深逐级切除的方式;放、化疗及联合治疗疗效尚不确切。     

膀胱混合癌的诊断与治疗(附13例报告)

目的：提高膀胱混合癌的诊断和治疗水平。方法：结合文献对收治的13例膀胱混合癌的临床表现、诊断、治疗及预后进行分析。结果：13例膀胱混合癌中,移行细胞癌加腺癌5例,移行细胞癌加鳞癌4例,癌肉瘤3例,移行细胞癌加低分化腺癌加小细胞神经内分泌癌1例,其中T_2期3例,T_3期10例;G_2 2例,G_311例。作TURBt 1例,膀胱部分切除术5例,膀胱全切术7例,其中回肠膀胱2例,输尿管皮肤造口术1例。结论：膀胱混合癌是一种恶性程度很高的肿瘤,预后差,早期诊断困难。手术切除是主要治疗方法。     

膀胱腺癌的诊断和治疗(附29例报告)

目的提高膀胱腺癌的诊断与治疗水平。方法29例中原发性膀胱腺癌18例，其中行全膀胱切除、尿流改道11例，膀胱部分切除7例；脐尿管腺癌9例，6例行扩大膀胱部分切除术，3例行全膀胱切除、尿流改道；印戒细胞癌2例，行全膀胱切除、尿流改道术。结果4例患者失访，25例患者随访时间为5个月一10年。生存1年者17例（64％），生存2年15例（60％），生存5年5例（20％），生存时间超过5年者均为早期患者。结论早期诊断、鉴别原发性膀胱腺癌与脐尿管腺癌、选择合适的手术方式是膀胱腺癌治疗的关键。     

膀胱混合癌的临床特征

目的:探讨膀胱混合癌的临床特征。方法:回顾性分析1990年6月~2004年8月收治的16例膀胱混合癌患者的临床资料,对该病的临床表现,诊断和治疗以及预后情况进行讨论。结果:膀胱混合癌16例,占同期230例膀胱恶性肿瘤的6.9%,其中移行、鳞状细胞混合癌7例,移行、腺细胞混合癌4例,移行、鳞状、腺细胞混合癌3例,鳞状、腺细胞混合癌2例。多数患者以膀胱刺激症为主要临床表现,治疗以膀胱全切为主,术后1、3和5年的生存率分别为81.3%、56.3%和12.5%。结论:膀胱混合癌以膀胱刺激症状为主要临床表现,恶性程度高,早期诊断困难。根治性全膀胱切除术有助于提高生存率。     

膀胱混合癌的诊断和治疗（附18例报告）

目的 探讨膀胱混合癌的临床特征.方法 结合文献对收治的18例膀胱混合癌患者的临床表现、诊断、治疗及预后进行分析.结果 18例膀胱混合癌中移行细胞癌＋腺癌7例,移行细胞癌＋鳞癌4例,移行细胞癌＋鳞癌＋腺癌2例,移行细胞癌＋小细胞未分化癌4例,移行细胞癌＋腺癌＋小细胞癌1例,经尿道膀胱肿瘤电切术1例,膀胱部分切除术5例,膀胱全切术12例（其中回肠膀胱术7例,输尿管皮肤造口术4例,输尿管乙状结肠吻合术1例）.结论 膀胱混合癌恶性程度高、预后差、早期诊断困难,手术切除是主要治疗方法.     

肺鳞状细胞癌81例临床分析

目的 分析81例肺鳞状细胞癌（鳞癌）临床特征，提高早期诊治率。方法 回顾性分析81例肺鳞癌诊断、手术、治疗及随访资料。结果 患者平均年龄62岁，男：女为2．2：1，有吸烟史76例（93．8％），平均26年，全组均有呼吸道症状，合并全身症状14．8％（12例）。确诊时间2～7个月。手术切除病肺63例（77．8％），术后放、化疗。未能切除18例中10例放、化疗。随访中位数5年以上。80例得到随访，1、3、5年生存率为90％（72例）、65％（52例）、47．5％（38例）。结论 肺鳞癌以老年男性多见，易误诊，手术切除率低，早期手术5年生存率高。     

膀胱混合癌的诊治及死亡原因分析(附10例报告)

目的　提高膀胱混合癌的诊治水平。方法　结合文献对收治的 10例膀胱混合癌的临床表现、诊断、治疗及预后进行讨论。结果　 10例膀胱混合癌占同期 44 2例膀胱肿瘤的 2 .2 % ,其中移行、鳞状细胞混合癌 7例 ,鳞、腺混合癌 2例 ,移行、腺、未分化混合癌 1例 ;行膀胱部分切除术 8例 ,行根治性全膀胱切除术 2例 ;术后 9例获随诊 ,生存期 7个月～ 6年。结论　膀胱混合癌恶性程度高、易转移 ,早期不易诊断 ,预后极差。手术切除是主要的治疗方法。早期诊断和及时综合治疗是提高生存率的关键     

非血吸虫性膀胱鳞状细胞癌诊疗和预后分析(附21例报告)

目的:探讨非血吸虫性膀胱鳞状细胞癌的病因、诊断、治疗及预后情况。方法:回顾分析21例经术后病理检查证实为膀胱鳞癌患者的临床资料,包括其临床症状、检查、治疗及预后情况,对其预后情况进行相关的统计分析。结果:21患者中主要症状表现为血尿、膀胱刺激症状、泌尿系感染等。患者1年、2年及5年生存率分别为55%、30%和5%,中位生存期16.1个月。初次就诊时T1期0例,4例发现盆腔淋巴结转移,1例发现肺部转移。接受根治性膀胱全切的患者生存期明显长于未行根治性膀胱全切的患者。随着T分期的增高,患者生存期逐渐减短;盆腔淋巴结转移的4例患者分别于术后8、10、11、18个月死亡,而未发现淋巴结转移的患者中有6例存活至少2年或以上,最长者目前随访75个月仍生存;不同肿瘤分级患者生存期无明显差异。部分患者接受放化疗等辅助治疗,但对患者预后改善不明显。结论:膀胱鳞癌预后差,早期诊断很重要,应尽早行根治性膀胱全切+盆腔淋巴结清扫术以改善患者预后,放化疗在膀胱鳞癌治疗中的作用仍需进一步探讨。     

膀胱全切原位尿流改道术治疗膀胱非尿路上皮癌的疗效评价

目的：评价膀胱全切原位尿流改道术治疗膀胱非尿路上皮癌的疗效.方法：对17例膀胱非尿路上皮癌患者行根治性膀胱全切,盆腔淋巴结清扫;然后取一段肠管缝制成新膀胱,分别与输尿管和尿道残端吻合,实现原位尿流改道.结果：手术均获成功,手术时间172～380 min,平均310 min.16例获得随访,平均随访67个月（1～16年）.6例因肿瘤复发或转移于5年内死亡,2例死于非肿瘤因素,1例仍在随访,7例存活已达5年.结论：根治性膀胱全切原位尿流改道术治疗膀胱非尿路上皮癌,具有较好的治疗效果,能明显改善患者生活质量.     

A case of squamous cell carcinoma of the urinary bladder associated with bladder calculi

A case of squamous cell carcinoma of the urinary bladder associated with a bladder stone in a 43-year-old man is reported. Because a 1 cm x 1 cm sized mass was found in the right lateral side of the dome at the time of vesicolithotomy, partial cystectomy was performed. The weight of the stone was 285 g and the tumor was histologically diagnosed as squamous cell carcinoma, grade 2, pT2. Radical cystectomy with ileal conduit was sandwiched by a total of 6 cycles of chemotherapy with PVB. Twelve cases of squamous cell carcinoma of the urinary bladder associated with a bladder stone(s) from the Japanese literature are reviewed, and the relationship between bladder stone, leukoplakia and squamous cell carcinoma discussed.     

膀胱副神经节瘤的诊断和治疗

目的：探讨膀胱副神经节瘤的临床特点及诊治疗效。方法：对5例膀胱副神经节瘤患者的临床资料进行回顾性分析。结果：5例患者,男2例,女3例,平均46（36～77）岁。经尿道膀胱肿瘤电切（TURBT）2例,开放膀胱部分切除术3例。5例患者随访1～7年,1例术后3年肿瘤复发行TURBT,术后病理诊断为移行细胞癌1～2级。1例术后6年复发,伴有左肾重度积水,左肾无功能,行根治性膀胱切除加左肾输尿管切除加右输尿管皮肤造口。3例患者未见肿瘤复发及转移。结论：膀胱副神经节瘤临床少见,其临床表现有一定特点,对于排尿时伴有相应副神经节瘤临床表现的患者应除外膀胱副神经节瘤的可能,治疗方法主要以手术为主。     

Noninvasive squamous lesions in the urinary bladder: a clinicopathologic analysis of 29 cases

Noninvasive squamous lesions are distinctively uncommon in biopsies of the urinary bladder with the exception of nonkeratinizing squamous metaplasia. The clinical significance of these squamous lesions in the bladder remains to be explored. A total of 29 cases of transurethral biopsies and resections of the bladder containing noninvasive squamous lesions (excluding nonkeratinizing metaplasia) were studied from the consult files of one of the authors. These cases included keratinizing squamous metaplasia (5), verrucous squamous hyperplasia (5), squamous papilloma (5), condyloma acuminatum (3), and squamous cell carcinoma in situ (CIS) (11). Immunohistochemistry for epithelial growth factor receptor (EGFR) and in situ hybridization for wide-range human papillomavirus was performed on 23 cases. The follow-up period ranged from 2 months to 3 years with an average of 1.5 years. After the initial diagnoses in biopsies of the bladder, 10 patients received cystectomies, and 7 patients received repeat tissue sampling of the bladder. Of the 5 patients with keratinizing squamous metaplasia, 2 patients had invasive urothelial carcinoma with squamous features in their cystectomy specimens at intervals of 3 and 14 months, respectively, 1 had persistent keratinizing squamous metaplasia on rebiopsy. Of the 5 patients with verrucous squamous hyperplasia, 1 patient had invasive squamous cell carcinoma at cystectomy at an interval of 14 months, 1 had squamous cell CIS on rebiopsy, 1 had persistent verrucous squamous hyperplasia on rebiopsy, and 2 had no evidence of disease at 6 and 24 months. Of the 5 patients with squamous papilloma, 1 patient had low-grade urothelial carcinoma at cystectomy at an interval of 21 months (h/o low-grade urothelial carcinoma preceding papilloma diagnosis), 2 were free of lesions at rebiopsy. Of the 3 patients with condyloma acuminatum, 1 had squamous CIS at cystectomy at an interval of 3 months, 1 had invasive squamous cell carcinoma at 20 months. Of the 11 patients with squamous cell carcinoma in situ (CIS), 3 patients had invasive squamous cell carcinoma at intervals of 2, 3, and 4 months, respectively, 1 had invasive urothelial carcinoma with squamous features in cystectomies at an interval of 12 months, 1 had squamous cell CIS at 10 months, 1 had high-grade urothelial carcinoma (not otherwise specified) at rebiopsy at an interval of 6 months, and 1 had no evidence of disease at 8 months. Among the 9 patients with invasive carcinoma, 4 patients died in the period of 0.5 to 3 years after the diagnoses. Immunohistochemical study with EGFR demonstrated strong signals in 20 cases and no signals in 2 cases. Wide-range human papillomavirus DNA signal was detected in 1 case of condyloma acuminatum and 1 case of squamous cell CIS. Keratinizing squamous metaplasia, verrucous squamous hyperplasia, and condyloma acuminatum in the urinary bladder can be associated with subsequent or concurrent in situ, or invasive squamous carcinoma and should be closely followed. Squamous cell CIS in the urinary bladder is often associated with subsequent or concurrent invasive carcinoma with squamous differentiation. Enhanced expression of EGFR in these bladder squamous lesions suggests that EGFR may represent a logic therapeutic target in those squamous lesions that are difficult to manage clinically.     

泌尿系小细胞癌的诊断及治疗（附11例报告）

目的：探讨泌尿系小细胞癌的诊治方法、疗效及预后。方法：回顾性分析我院2003年1月～2012年12月收治的t1例泌尿系小细胞癌的病理、临床特征、诊断方法、治疗方法等资料,并对患者治疗效果、生存期等进行分析。结果：11例患者,男9例,女2例,平均年龄66．9（57～83）岁,肿瘤位于膀胱5例（1例为女性）,右肾3例（1例为女性）,左肾1例,前列腺2例。按TNM分期,膀胱肿瘤：T2bNnM01例,T2bN1M0 1例,2例均行根治性膀胱全切＋肠代膀胱术,分别于术后24个月及13个月死亡;T2bN2M1 1例,T3bN2M1 1例,此2例行根治性膀胱全切＋放疗＋化疗,分别于术后9个月、12个月死亡;T4N2M1 1例,行放疗＋化疗,3个月后死亡。肾脏肿瘤：T1aN0M01例,T1nN0M0 1例,T2bN1M0 1例,T3bN2M1 1例,均行根治性肾切除术＋放疗＋化疗,3例于术后6个月、13个月、24个月死亡,1例至今4年尚存活。前列腺肿瘤：T1cN0M1b 1例,行前列腺电切＋放疗＋化疗;T3bN1M1c 1例,行放疗＋化疗,随访时分别死于术后25个月及15个月。11例患者生存期最短3个月,目前最长48个月,平均17．5个月;1年生存率63．6％（7／11）,5年生存率目前为0。结论：泌尿系小细胞癌恶性度高,预后差,手术联合放化疗可能会延长患者生存期、改善其生活质量。     

原发性膀胱小细胞癌诊治体会

目的 探讨膀胱小细胞癌的临床及病理特点.方法 回顾性分析9例膀胱小细胞癌的基本资料.男6例,女3例.年龄45～79岁,平均62岁.临床表现为肉眼血尿7例,排尿困难及下腹部疼痛2例.肿瘤直径0.5～7.0 cm,平均2.0 cm;多发2例,单发5例,全膀胱弥漫性生长2例.7例行尿脱落细胞学检查,阳性4例.9例均行手术治疗,其中4例术前诊断为浅表性者行TURBt,术后均定期行吡柔比星膀胱灌注,1例化疗3个周期;膀胱部分切除2例,均定期行吡柔比星膀胱灌注,1例化疗2个周期;根治性膀胱全切3例,静脉化疗2例.结果 术后病理检查:肿瘤细胞体积小,呈圆形,胞质稀少,核浓染,缺乏巢状结构.免疫组化染色:嗜铬素A(+)、神经元特异性烯醇化酶(+).诊断为小细胞癌,其中1例含移行细胞癌成分,1例合并前列腺癌.1例术前检查显示高血钙(3.15 mmol/L)和低血磷(0.61 mmol/L),术后1个月血钙及血磷恢复正常.保留膀胱者随访4例,3例分别于术后4、9、25个月死于转移,1例术后化疗者随访24个月未见复发及转移.膀胱全切3例中2例分别于术后2、28个月死亡,1例术后随访32个月未见肿瘤复发及转移.结论膀胱小细胞癌恶性程度高,预后差,根治性膀胱全切加全身化疗是主要的治疗方法,保留膀胱的手术应配合全身化疗.决定预后的是肿瘤的临床分期及治疗方法.

Abstract：

Objective To investigate the clinical and pathological features of small cell carcinoma of the urinary bladder. Methods The pathological and clinical data of 9 cases of small cell carcinoma were analyzed retrospectively. There were 6 males and 3 females, ages 45 to 79 years (mean age, 62 years). Clinical manifestations of 7 cases included gross hematuria and dysuria, the other 2 cases experienced lower abdominal pain. The mean tumor size was 2.0 cm (ranged, 0.5 to 7.0 cm). Two cases had multiple tumors and 5 cases had single tumors. The growth pattern in 2 cases was diffuse growth in the whole bladder. In 4 cases tumor cells were found in urine cytology. All 9 patients underwent surgical treatment, including TURBt. Four patients were diagnosed as superficial tumors before operation. All the patients underwent regular theprubicine irrigation in the bladder. One case underwent additional intravenous chemotherapy for 3 cycles. Partial cystectomy was performed in 2 cases, with regular theprubicine irrigation in bladder and 1 case underwent intravenous chemotherapy for 2 cycles. Radical cystectomy was performed in 3 cases, with 2 cases undergoing intravenous chemotherapy after operation. Results Pathological findings showed that tumor cells were small and round in shape. These hyperchromatic nuclei showed limited cytoplasm with lack of nesting characters. CgA and NSE were positive in immunohistochemistry. The final diagnosis was small cell carcinoma, with 1 case accompanied with transitional cell carcinoma and 1 case accompanied with prostate cancer. One case showed high preoperative serum calcium (3.15 mmol/L) and low serum phosphate (0.61 mmol/L), which returned to normal 1 month after operation. Four cases who′s bladder was preserved were followed up, 3 cases were alive for 4, 9 and 25 months after operation. The 1 case who underwent intravenous chemotherapy was followed up for 24 months and there was no sign of relapse or metastasis. In all the 3 cases with radical cystectomy, 2 cases died 2 and 28 months postoperativly. Another case with adjuvant chemotherapy was followed up for 24 months without recurrence or metastasis. Conclusions Small cell carcinoma of the urinary bladder is highly malignant with poor prognosis. Radical cystectomy in combination with systemic chemotherapy has better efficacy. Retained bladder surgery with systemic chemotherapy is an alternative choice. The most important factors which influence the prognosis of the tumor are clinical stage and therapeutic methods.     

腹腔镜根治性膀胱切除术治疗肌层浸润性膀胱癌(附21例报告)

目的:探讨腹腔镜根治性膀胱切除术治疗肌层浸润性膀胱癌的初步经验,评价此术式的可行性及临床疗效。方法:回顾分析21例肌层浸润性膀胱癌患者行腹腔镜根治性膀胱切除术的临床资料,患者均行腹腔镜下标准盆腔淋巴结清扫、根治性膀胱切除术及尿流改道术,包括11例Bricker回肠膀胱术,4例输尿管皮肤造口术,6例Studer原位新膀胱术。观察手术时间、术中出血量、术后肠道功能恢复时间、术后并发症及手术疗效。结果:21例手术均获成功。手术时间平均(390±46.2)min,术中出血量平均(270±101.1)ml,1例输浓缩红细胞2个单位。术后3~5 d恢复肠蠕动。术后并发症发生率19.0%(4/21)。平均随访(12±5.5)个月,总生存率85.7%(18/21),1例死于肿瘤远处转移,2例死于心脑血管疾病。结论:腹腔镜根治性膀胱切除术具有患者创伤小、出血少、术后康复快等优点,是治疗肌层浸润性膀胱癌安全、有效、可行的方法。具备开放根治性切除术的手术经验及腹腔镜技术熟练的医院可尝试开展。初期开展,Bricker回肠膀胱术可作为首选的尿流改道术式。