脐尿管癌临床特点及治疗体会（附6例报告）

目的：探讨脐尿管癌的临床特点,增加对脐尿管癌的了解,提高诊治水平。方法：回顾性分析收治的6例脐尿管癌患者的临床资料：6例患者中,1例行膀胱部分切除术,2例行根治性全膀胱切除术,3例行扩大性膀胱部分切除术。结果：术后随访6个月～3年,1例行膀胱部分切除术患者术后7个月原位复发．再行根治性全膀胱切除术,术后辅以全身化疗。1例行根治性全膀胱切除术患者术后13个月死亡。3例行扩大性膀胱部分切除术患者中,1例术后9个月复发,并与6个月后死亡,其余2例分别随访6个月、18个月未见复发及转移。结论：脐尿管癌是一种少见的膀胱恶性肿瘤,预后差。影像学检查及膀胱镜检查的综合应用是诊断脐尿管癌的主要方法。手术治疗是脐尿管癌的主要治疗方法,扩大性膀胱部分切除术是值得推荐的手术方式。     

膀胱腺癌(附26例报告)

目的 提高膀胱腺癌的诊治水平。方法 回顾分析１９８０年１月至１９９８年１月收治的２６例膀胱腺癌资料。其中脐尿管腺癌１２例,原发性膀胱腺癌１４例。结果 ２６例中膀胱部分切除术８例,全膀胱切除＋尿流改道术１３例,根治性全膀胱切除＋尿流改道术２例,姑息性尿流改道术３例。随访１年生存率５２％,５年生存率２０％。结论 较局限的脐尿管腺癌可行广泛性部分膀胱切除术,原 性膀胱腺癌应行根治性全膀胱切除。     

脐尿管腺癌（附10例报告）

目的提高脐尿管腺癌的诊断与治疗水平。方法回顾分析自1980年以来收治10例脐尿管腺癌的诊断方法,包括膀胱镜、B超或CT扫描。结果脐尿管腺癌主要临床症状有肉眼血尿,耻骨上肿块。6例行扩大性膀胱部分切除,4例行膀胱部分切除术,其中2例复发。结论扩大性膀胱部分切除术可作为脐尿管腺癌的主要手术方式。     

膀胱腺癌的诊断和治疗（附21例报告）

目的提高膀胱腺癌的诊治水平。方法回顾性分析21例膀胱腺癌临床资料，其中原发性膀胱腺癌14例，全膀胱切除 尿流改道术4例，膀胱部分切除6例，经尿道膀胱肿瘤电切术3例，姑息性尿流改道术1例；脐尿管腺癌7例，扩大膀胱部分切除术4例，根治性全膀胱切除 尿流改道术2例，放弃治疗1例。结果5年生存率18％(3／16)。结论原发性膀胱腺癌宜采用根治性全膀胱切除术，脐尿管腺癌宜采用扩大膀胱部分切除术，综合性治疗有助于提高复发、转移患者的生存率。     

脐尿管癌3例报告

目的 提高脐尿管癌的诊断和治疗水平。方法 总结3例脐尿管癌患者临床资料和随访结果，并复习国内外文献报道进行分析讨论。结果 3例行扩大性膀胱部分切除术，即包括膀胱顶部、腹横筋膜、脐尿管和部分腹膜连同肿瘤整块切除，无1例局部复发。2例分别无瘤生存6年和12个月，1例死于肺、骨、腹腔多发转移。结论 扩大性膀胱部分切除术可作为脐尿管癌的主要手术方式，对复发、转移病例应积极采取综合治疗。     

脐尿管肿瘤5例报告及文献复习

目的 探讨脐尿管肿瘤的临床特点和诊疗方法,提高诊治水平.方法 总结2009年至2012年收治的5例脐尿管癌患者的临床资料及随访结果,结合国内外文献报道进行分析讨论.结果 5例患者中3例行扩大性膀胱部分切除,1例行膀胱部分切除术,1例转移患者仅行化疗.随访6～48个月.平均20个月.5例患者中未手术者于治疗后6个月死于多处转移,另有1例术后12个月死于其他疾病,其余3例截至2013年5月仍在随访中,未出现肿瘤复发.结论脐尿管肿瘤较为少见,其恶性程度高,预后差,血尿是其最常见症状,扩大性膀胱部分切除术为其主要治疗手段,早期诊断、早期治疗是影响预后及存活的重要因素.     

脐尿管癌的临床特点及预后分析

目的 探讨脐尿管癌的临床特点和影响预后因素. 方法 回顾性分析2002年至2007年收治的5例脐尿管癌患者的临床和病理资料.重点探讨脐尿管癌的临床特点、诊断、治疗方式及预后因素. 结果 5例患者中4例行扩大性膀胱部分切除.1例行膀胱部分切除术.随访6～48个月,平均18个月.1例患者术后6个月死于多处转移,4例患者未出现肿瘤复发并生存至今. 结论 脐尿管癌是一种少见的恶性肿瘤,预后差,手术为主要治疗手段,早期尽可能彻底的扩大性膀胱部分切除术可以达到长期无病生存的效果.     

膀胱腺癌（附31例报告）

１９６０年１月～１９９３年１月收治膀胱腺癌３１例，经病理证实原发性膀胱腺癌２５例，脐尿管腺癌６例。就临床表现、膀胱镜检查及膀胱造影等特点，结合文献分析讨论组织起源、早期诊断、及时正确治疗的重要性。手术治疗主张广泛膀胱部分切除术及根治性膀胱全切术，联合放疗，化疗。本组５年生存率２２．６％。     

膀胱腺癌的诊治(附22例报告)

目的：探讨膀胱腺癌的诊治效果。方法：回顾性分析22例膀胱腺癌的临床资料，其中原发性膀胱腺癌19例，脐尿管癌3例。结果：22例有8例次行根治性膀胱全切术，4例行次膀胱全切术，2例次行扩大膀胱部分切除术，3例次行膀胱部分切除术，5例次行经尿道膀胱肿瘤切除术。术后随访1－5年，其2年生存率为55.5%，5年生存率为33.3%。结论：扩大性膀胱部分切除术是脐尿管癌的主要手术方式，原发性膀胱腺癌多行根治性膀胱全切术，总体疗效需进一步提高。     

脐尿管癌的诊断和治疗(附9例报告)

目的探讨脐尿管癌的诊断和治疗方法及其疗效。方法回顾性分析广西医科大学附属肿瘤医院1999年7月至2009年12月收治的9例脐尿管癌患者的临床资料和随访结果,其中黏液腺癌6例、肠型腺癌1例、尿路上皮癌2例。结果本组患者最常见的临床症状为血尿和膀胱刺激症状,膀胱镜检查主要表现为膀胱顶部宽基底肿物,影像学检查常见膀胱顶前壁与腹壁之间软组织肿块影,多浸润膀胱壁。2例(Ⅲ期)膀胱部分切除者分别于术后7、9个月局部复发,并于1年内死亡。1例(Ⅳ期)晚期未切除者行化疗,无进展生存6个月,化疗后13个月死亡。6例行扩大性膀胱部分切除术,患者中1例(Ⅳ期)术后18个月因肺转移死亡,2例(Ⅲ期)术后32个月及41个月死亡,3例(Ⅲ期)分别为术后22、58和62个月,仍在随访中。结论脐尿管癌发病位置隐匿,术前诊断较为困难。治疗方法主要是行扩大性膀胱部分切除术,首次手术彻底切除肿瘤及对晚期及术后复发转移患者积极的综合治疗是提高脐尿管癌疗效的关键。本病的预后很差,临床分期与预后密切相关。     

Treatment methods as a prognostic factor in eight patients with urachal carcinoma

Between 1960 and 1982, 8 patients with urachal carcinoma underwent segmental resection of the bladder or en bloc resection, and their five-year survival rate was 50%. One patient each with well, moderate and poorly differentiated adenocarcinoma and one patient with transitional cell carcinoma, died of cancer from 6 months to 2 years and 2 months after operation (mean duration: 1 year and 3 months). The patient with well differentiated adenocarcinoma underwent en bloc resection and was recognized to have peritoneal involvement of the tumor at the operation. The remaining three patients were diagnosed to have tumors confined to their bladder and urachal remnant and were treated with segmental resection of the bladder. Two patients each, with well and moderately differentiated carcinoma confined to their bladder and urachal remnant, were treated with en bloc resection and have been surviving from 8 years and 5 months to 24 years and 10 months (mean duration: 13 years and 7 months) postoperatively as of Dec. 1987. Therefore, patients with well and moderately differentiated adenocarcinomas confined to the bladder and the urachal remnant could be expected to survive longer by en bloc resection.     

脐尿管癌的临床病理学特点及手术疗效观察

目的 探讨脐尿管癌的临床病理学特点,提高诊疗水平. 方法脐尿管癌患者7例.男6例,女1例.平均年龄52(26～75)岁.临床表现间歇无痛肉眼血尿5例,血尿伴尿中有黏液1例,血尿伴下腹部疼痛1例.术前检查包括彩色多普勒超声、膀胱镜、尿脱落细胞、CT、IVU.肿瘤直径平均3.6(2.0～6.0)cm.7例中行扩大性膀胱部分切除6例,行膀胱部分切除术1例. 结果 病理报告黏液腺癌5例,肿瘤细胞呈柱状,胞质内见空泡状黏液分泌特征;未特殊分类腺癌1例,癌细胞呈腺样排列,腺腔大小不等,形态不规则,癌细胞核大,染色质深;小细胞型内分泌癌1例,癌组织主要位于肌层及脂肪组织中,呈片状分布,癌细胞核小呈短梭形或圆形,可见空心菊形团结构,免疫组化神经元特异性烯醇化酶阳性.Sheldon分期ⅢA期6例,ⅢC期1例.1例术后3个月死于多发骨转移,1例术后15个月和2年分别出现膀胱颈部及尿道复发接受经尿道肿瘤电切术,余5例随访2～30个月,肿瘤无复发. 结论脐尿管癌是一种少见类型的恶性肿瘤,预后差,早期扩大性膀胱部分切除术可以达到长期无瘤生存效果,脐尿管下端体积较小的肿瘤可行保留脐部手术,放化疗无肯定疗效.     

Long-term clinical results of 5 cases of urachal carcinoma

Five cases of urachal carcinoma experienced in our hospital during the past 20 years are reported. Surgical resection is considered as the first treatment option of this disease, and other therapies to be less beneficial. Complete surgical extirpation and detection of recurrence in the early stage are considered to be important since local recurrence occurs frequently. We enforced the bladder preserving operation for 4 patients with urachal carcinoma except for 1 case with peritonitis carcinomatosa in the initial diagnosis, and multiple surgical treatment was performed again for 2 patients with recurrence. The bladder was preserved with no evidence of malignancy in three patients for 24, 19 and 5 years, respectively. In the initial management of urachal carcinoma, we believe that bladder-preserving surgery should be considered in selected cases though close follow-up is demanded. Herein, we also report the immunohistochemical study of paraffin-embedded specimens using anti-CEA, CA19-9, CA125 and p53 monoclonal antibodies. The positive reaction was observed in 100% (5/5) for CEA, 80% (4/5) for CA19-9, and 20% (1/5) for CA125. These results suggest that CEA may be a useful marker in the diagnosis of this neoplasm and early detection of its recurrence. Nuclear accumulation of p53 was observed in 80% (4/5), but it did not correlate with the disease progression.     

Metastatic brain tumor originating from urachal carcinoma: case report

The authors presented a patient with metastatic brain tumor originating from urachal carcinoma. A 64-year-old female was admitted to our hospital with complaints of memory disturbance, indifference and apathy of 3 months duration. Head CT and MRI on admission showed a round mass with perifocal edema in the right frontal lobe. After administration of Gd-DTPA, the mass lesion showed ringed enhancement effect. Pelvic MRI scan revealed a bladder tumor, which was diagnosed as urachal carcinoma. The brain lesion was suspected to have metasta sized metastatic from urachal carcinoma, and was excised by craniotomy. Histology of the brain tumor was identical to that of urachal carcinoma. Postoperatively the patient received local radiation therapy, but died of multiple metastasis to lung and local recurrence, 18 months later. Urachal carcinoma is an extremely rare tumor, comprising 0.17-0.34% of all bladder tumors. Though this rare tumor carries a poor prognosis, it may be effective for longer survival of a patient to treat the metastatic brain lesion with surgery and radiation.     

Urachal carcinoma: contemporary surgical outcomes

PURPOSE: We determined surgical outcomes in a contemporary series of patients who underwent surgery for urachal carcinoma. MATERIALS AND METHODS: A cohort of 50 patients with clinically staged localized urachal carcinoma underwent extended partial cystectomy, including the urachal tumor mass and entire urachus. The patients were followed a median of 5+ years for cancer-free survival. RESULTS: Of the 50 patients 93% (26 of 28) with tumor confined to the urachus and bladder survived compared to 69% (9 of 13) with extravesical or peri-urachal tumor invasion and none (9 patients) with tumor invasion into the peritoneal cavity. Local recurrence was noted in 9 patients (18%) and 2 had salvage therapy. The most significant predictors of survival were pathological tumor stage and negative surgical margins. CONCLUSIONS: Wide resection of the tumor mass and entire urachus resulting in negative soft tissue and bladder margins cures the majority of nonmetastatic urachal cancers.     

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。     

腹腔镜扩大膀胱部分切除术治疗成人脐尿管肿瘤五例报告并文献复习

目的探讨腹腔镜扩大膀胱部分切除术治疗成人脐尿管肿瘤的可行性和临床疗效。 方法回顾性分析我院采用普通腹腔镜和达芬奇机器人辅助腹腔镜下扩大膀胱部分切除术治疗脐尿管肿瘤5例临床资料,手术切除范围包括脐尿管、脐孔、脐尿管肿物、脐正中韧带、部分腹膜以及与脐尿管肿物相连的部分膀胱顶部,对手术时间、术后住院天数、有无术后并发症及随访有无肿瘤复发等指标进行分析,评价手术疗效。检索国内外相关文献,讨论脐尿管肿瘤的发病特点、影像学特征以及治疗方法。 结果5例手术均成功,无中转开放,平均手术时间140 min,术中出血少,术中术后无严重并发症出现,术后平均住院天数7.4 d,其中3例行术后辅助化疗3个疗程,化疗方案为顺铂+紫杉醇,术后随访1~4年无复发。术后病理诊断1例为绒毛状腺瘤,3例为脐尿管黏液腺癌,1例为浸润性高级尿路上皮癌,所有病例切缘及淋巴结均未见癌累及。 结论腹腔镜扩大膀胱部分切除术治疗成人脐尿管肿瘤,是一种安全、有效的方法。     

Case of urachal cancer treated by neoadjuvant chemotherapy with FOLFOX4 (oxaliplatin, 5-FU and leukovolin)

A 52-year-old woman was referred to our hospital for treatment of urachal cancer. She complained of supurapubic dull pain and gross hematuria. Computed tomography and magnetic resonance imaging showed a non-papillary sessile tumor, which was located on the dome of the bladder and invaded the small intestine. The tumor was diagnosed as Sheldon's stage IIIC urachal cancer. After three courses of neoadjuvant chemotherapy with FOLFOX4 (oxaliplatin, 5-FU and leukovolin), the tumor was reduced from 7 x 6 cm to 5.5 x 5 cm in size. Consequently, the patient underwent an en-bloc resection of the urachal tumor with the dome of the bladder and the parts of the ileum invaded by the tumor. One course of adjuvant chemotherapy (FOLFOX4) was performed. Surgical specimen revealed histologically well differentiated squamous carcinoma and invasion to the propria of the ileum. The surgical margins were negative for the cancer. For 1.5 years after the surgery, no local recurrence or distant metastasis has been observed.     

膀胱腺癌的诊断与处理(附41例报告)

目的　提高膀胱腺癌的诊断与治疗水平。　方法　分析经手术病理证实的 4 1例膀胱腺癌患者资料。原发性膀胱腺癌 18例 ,作全膀胱切除 尿流改道 8例 ,膀胱部分切除 10例 ;脐尿管腺癌 12例中扩大膀胱部分切除 11例 ;转移性腺癌 11例均切除膀胱病灶。　结果　膀胱腺癌占同期膀胱癌的 3.2 %。 37例随访 5个月～ 10年 ,1年生存 19例 (5 1.3% ) ,2年生存 16例 (43.2 % ) ,5年生存 8例 (2 1.6 % )。　结论　原发性膀胱腺癌宜行根治性全膀胱切除术 ,脐尿管腺癌应作扩大性膀胱部分切除 ,对复发、转移性患者应采用综合治疗 ,以提高生存率