膀胱部分切除术在肌层浸润性膀胱癌治疗中的价值

目的探讨膀胱部分切除术在肌层浸润性膀胱癌治疗中的价值。方法回顾性分析105例肌层浸润性膀胱癌患者的临床资料,均接受了以膀胱部分切除术为主的综合治疗。通过术前评估,选择临床分期T2～3期、无盆腔淋巴结转移、瘤体位于膀胱顶部/侧壁/后壁/前壁、有安全外科切缘、切除肿瘤后有足够膀胱容量的患者接受治疗。男性78例、女性27例,中位年龄63岁。膀胱部分切除术中用羟基喜树碱浸泡膀胱及切口,11例同时行双侧盆腔淋巴结清扫。肿瘤中位直径2.3cm,病理分期为T2期41例、T3期61例、T4期3例,病理分级为高级别67例、低级别38例。76例(72.3%)接受了综合治疗,其中20例肿瘤较大的患者行新辅助治疗,56例病理为T3～4期/脉管瘤栓/盆腔淋巴结转移的患者接受了辅助治疗。结果本组无围手术期死亡的患者,1例(1.0%)外科切缘阳性,未见切口种植。20例新辅助治疗的患者总反应率50.0%。95例患者获得随访,中位随访期34个月(9～70个月)。29例(30.5%)局部复发,其中16例行挽救性膀胱切除术。本组5年生存率53.5%。结论选择合适的肌层浸润性膀胱癌患者,采取以膀胱部分切除术为主的综合治疗疗效较为满意,患者需严密随诊。

Value of Partial Cystectomy in the Treatment for Muscle Invasive Bladder Carcinoma

Objective To study the value of partial cystectomy based multimodal treatment for muscle invasive bladder carcinoma.Methods We retrospectively reviewed clinical data of 105 patients with muscle invasive bladder carcinoma treated with partial cystectomy based multimodal treatment.Candidates selection criteria were clinical stage T2-3,no metastasis of pelvic lymph node,tumor located at the dome or lateral or posterior or anterior wall of bladder,having safe surgical edge and adequate bladder capacity after excision of tumor.Hydroxy camptothecin was used to dip bladder and wound in operation and 11 cases had bilateral pelvic lymph node dissection.The mean diameter of tumors was 2.3cm.Fourty-one patients had pathological stage of T2,61 had T3 and 3 had T4.Sixty-seven had high-grade and 38 had low-grade.Seventy-six(72.3%) had multimodal treatment.Twenty patients with bulk tumor had neoadjuvant therapy and 56 with pT3-4,vessel tumor embolus or lymph node metastasis had adjuvant therapy.Results There was no death during perioperative period in our series.One case had positive surgical margin.No wound recurrences was seen.The response rate was 50% of twenty patients who had neoadjuvant therapy.Ninety-five patients were followed up.The mean follow-up was thirty-four months.Twenty-nine cases had local recurrence and 16 had salvage radical cystectomy.The overall 5-year survival rate was 53.5% of our series.ConclusionIn highly selected patients with muscle invasive bladder cancer,partial cystectomy based multimodal treatment offers adequate tumor control.Patients should follow up intensively.