膀胱癌的诊断与治疗

在膀胱癌的诊断和治疗方面,每年都会有很大的进步,但尚需许多的工作来改善膀胱癌患者的预后.对于大多数浅表膀胱癌患者,经尿道电切和围手术期的化疗药物灌注仍是主要治疗方法;对于高危易进展的患者,应行膀胱内灌注卡介苗(包括维持剂量)的方法;对于肌层侵犯的患者应行根治性膀胱切除术.膀胱切除后新辅助化疗和辅助化疗的作用仍有待确定.目前化疗以甲氨蝶呤、长春新碱、阿霉素、顺铂联合用药或吉西他滨、顺铂联合用药为主,许多新的药物仍在研究中.     

膀胱癌的诊断与治疗

在膀胱癌的诊断和治疗方面,每年都会有很大的进步,但尚需许多的工作来改善膀胱癌患者的预后.对于大多数浅表膀胱癌患者,经尿道电切和围手术期的化疗药物灌注仍是主要治疗方法;对于高危易进展的患者,应行膀胱内灌注卡介苗(包括维持剂量)的方法;对于肌层侵犯的患者应行根治性膀胱切除术.膀胱切除后新辅助化疗和辅助化疗的作用仍有待确定.目前化疗以甲氨蝶呤、长春新碱、阿霉素、顺铂联合用药或吉西他滨、顺铂联合用药为主,许多新的药物仍在研究中.     

Diagnosis and staging of bladder cancer.

The need for prompt diagnosis and accurate staging of bladder cancer cannot be over-emphasized, as delays in diagnosing the tumor are clearly associated with a poor prognosis. Accurate staging using the American Joint Committee system is essential if clinicians are to compare the results of different therapies.     

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,TUBRT 36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 of bladder cancer by transurethral ultrasonic scanning

Transurethral ultrasonographic examination was performed on a total of 24 patients with 40 bladder tumors to evaluate the accuracy of the method to detect bladder tumors and to compare ultrasonographic staging of bladder tumors with pathological staging. The results showed that it was difficult to detect bladder tumors of any size located in the bladder neck or dome and those less than 0.5 cm in diameter located anywhere, indicating the difficulty in tumor staging. On the other hand, diagnostic accuracy was approximately 90% for the tumors larger than 0.5 cm in diameter. Therefore, if a tumor with a diameter larger than 0.5 cm is detected by cystoscopy, we believe that urethral ultrasonographic examination should be performed as a routine protocol after the cystoscopy.     

Interactions between UFT and anticoagulants in lung cancer patients

In order to study the interactions between UFT and anticoagulants, the plasma and tissue concentrations of 5-FU, uracil and FT-207 were examined in patients with lung cancer. Higher plasma concentrations of 5-FU and uracil were observed in the patients who were given warfarin and ticlopidine beforehand, whereas the concentrations of FT-207 were almost the same in the patients who were given anticoagulants as in those who were not. This may be interpreted as an inhibition of dihydrouracil dehydrogenase, the common metabolizing enzyme of 5-FU and uracil, by anticoagulants. With regard to the tissue concentrations, higher levels of 5-FU and uracil in the tumor and lymph nodes were obtained after anticoagulants were given beforehand. Concentrations of FT-207 in these tissues, however, were almost the same in the patients who were given anticoagulants as in those who were not. We thus concluded that an increase of 5-FU in tumor cells and lymph nodes can be achieved after elevating the plasma concentrations of ordinary oral doses of UFT by using anticoagulation therapy beforehand.     

Interactions between UFT and anticoagulants in lung cancer patients

In order to study the interactions between UFT and anticoagulants, the plasma and tissue concentrations of 5-FU, uracil and FT-207 were examined in patients with lung cancer. Higher plasma concentrations of 5-FU and uracil were observed in the patients who were given warfarin and ticlopidine beforehand, whereas the concentrations of FT-207 were almost the same in the patients who were given anticoagulants as in those who were not. This may be interpreted as an inhibition of dihydrouracil dehydrogenase, the common metabolizing enzyme of 5-FU and uracil, by anticoagulants. With regard to the tissue concentrations, higher levels of 5-FU and uracil in the tumor and lymph nodes were obtained after anticoagulants were given beforehand. Concentrations of FT-207 in these tissues, however, were almost the same in the patients who were given anticoagulants as in those who were not. We thus concluded that an increase of 5-FU in tumor cells and lymph nodes can be achieved after elevating the plasma concentrations of ordinary oral doses of UFT by using anticoagulation therapy beforehand.     

直肠癌根治术后并发神经源性膀胱的诊断和处理

目的　提高直肠癌术后神经源性膀胱的诊断和治疗水平。方法　 2 3例直肠癌术后并发神经源性膀胱的患者行尿流动力学检查 ,明确诊断 ,并给予相应治疗 ,观察疗效。结果　 2 2例患者经治疗后恢复正常的排尿 ,1例尿失禁患者在随访 6个月后仍未恢复正常。结论　直肠癌术后并发神经源性膀胱的患者应早期行尿动力学检查 ,并根据尿流动力学检查的结果采取相应的治疗     

Diagnosis of bladder cancer on intravenous pyelography. Analysis of 117 cases

A review of 117 cases of bladder carcinoma showed that the accuracy of x-ray diagnosis on the intravenous pyelogram-cystogram depended not only on the extent of the disease but also on the information supplied to the radiologist. Tumors were overlooked because they were (1) associated with enlarged prostates and trabeculations, (2) they were flat rather than exophytic, and (3) very small growths were confused with superimposed intestinal gas. If the radiologist maintains a high index of suspicion and the cystograms are of good quality, he should be able to identify the lesion in at least 80 per cent of the cases. There is little doubt that double contrast studies of the bladder can improve this yield significantly.     

Diagnosis and grading of bladder cancer and associated lesions.

Standardized classification and grading of urothelial carcinoma has now been achieved internationally. Uniformity of pathologic reporting should improve the comparability of different studies and therapies and provide more accurate information to urologists in managing patients.     

荧光原位杂交技术在膀胱肿瘤诊断中的应用

目的：评价荧光原位杂交技术（FISH）在膀胱肿瘤诊断中的应用价值。方法：20例正常人通过FISH技术检测9号染色体P16位点、3号染色体、7号染色体及17号染色体的变异情况,建立阈值。20例血尿患者留取晨尿,分别进行尿脱落细胞学检查和FISH检查。以至少两种探针检测结果超过阈值或一种探针检 测结果至少存在两种异常为诊断阳性。结果：20例血尿患者除1例为泌尿系结石、1例为BPH外,病理检查证实的18例膀胱肿瘤患者中,FISH检出16例,尿脱落细胞学检出4例。结论：FISH无创快速,检出率高,在膀胱肿瘤早期诊断中优于尿脱落细胞学检查方法。     

Urinary diversion and bladder substitution in patients with bladder cancer

For the majority of patients with invasive bladder carcinoma, radical cystectomy remains the gold standard of care. As a result the twentieth century has seen the continuous development of methods for reconstructing the urinary tract. Two decades ago the ileal conduit was by far the most commonly used method, whereas today methods geared toward patient continence are first choices in most centers. Some of these methods are unquestionably more complex than the ileal conduit, yet whether they actually yield uniformly improved quality of life is the cause of much debate. Many different variables play a role in determining the best type of reconstruction for an individual bladder cancer patient. This review analyzes the different factors that must be considered to obtain an optimal match between patient and reconstructive method.     

浸润性膀胱癌的保留膀胱综合治疗方法的临床观察

目的:探索保留膀胱手术+膀胱内灌注化疗+动脉灌注化疗治疗浸润性膀胱癌的临床疗效。方法:2003年5月～2012年2月,对经尿道膀胱肿瘤电切或膀胱部分切除后确诊为浸润性膀胱癌(T2N0M0)的56例保留膀胱的患者,给予动脉灌注化疗加膀胱灌注化疗。结果:56例患者均获得随访,随访6～98个月,平均36个月,53例(94.6%)患者无复发及转移,3例(5.4%)分别在术后6、8、12复发,复发患者均给予全膀胱切除术,无死亡病例,没有明显并发症。结论:保留膀胱手术后确诊的局限性浸润性膀胱癌的患者,采用经髂内动脉灌注化疗+膀胱内灌注化疗的联合治疗方法,能明显的提高疗效,有效地减少肿瘤的复发,显著的降低了静脉化疗的副作用,提高了患者的生活质量,患者易于接受,值得进一步探讨。     

Urinary cytology and bladder biopsy in patients with bladder cancer

Two hundred fifty patients with bladder tumor were evaluated over a three-year period. Cystoscopy, cytology, and random bladder and tumor biopsy were part of the workup. The follow-up of these patients resulted in a total of 509 cystoscopies, 772 specimens of bladder washings and urinary cytologies, and 503 tumor or selected mucosal biopsies. The value of cytologic study of bladder washings and cystoscopic urine samples as well as the importance of selected site mucosal biopsies in detecting "field changes" in the bladder epithelium associated with bladder tumors are discussed.     

共享决策在膀胱癌患者中的研究进展

阐述膀胱癌患者面临的决策挑战和共享决策的实施途径,分析共享决策在膀胱癌患者实施中的障碍因素(包括患者、医生及社会因素),提出应在我国推广共享决策理念、研制决策辅助工具、加强多学科合作、发挥专科护士的决策辅导作用的建议,以期提高膀胱癌患者决策自我效能和决策质量,减少决策后悔。