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。

Diagnosis and treatment of urachal carcinoma (report of 9 cases)

Objective To study the diagnosis,treatment and outcome of urachal carcinoma.Methods 9 cases of urachal carcinoma treated from July 1999 to December 2009 in the Tumor Hospital of Guangxi Medical University were analyzed retrospectively.6 cases were mucinous adenocarcinoma,1 case was adenocarcinoma and the other two were urothelial carcinoma.Results The most common complaints of the 9 patients were hematuria and irritative bladder symptoms.Cystoscopy mainly revealed broad-based tumors located at the dome of the bladder.Soft-tissue masses between the bladder dome and the abdominal wall were detected by imaging examinations and the wall of the bladder was often invaded.Of the 9 cases,2 cases(Stage Ⅲ) received partial cystectomy and recurred at 7 months and 9 months of post-operation respectively,and both the patients died within 1 year after surgery.One advanced tumor patient(Stage Ⅳ),who did not undergo a surgical operation,received chemotherapy,achieved progression free survival for six months and died from extensive metastasis 13 months after chemotherapy.Among the 6 cases treated by extensive partial cystectomy,3 cases(2 Stage Ⅲ and 1 Stage Ⅳ) died at 1.5 to 4.0 years after the operation.The other 3 cases(Stage Ⅲ) remained alive up to the last follow-up date,two of them has survived over 5 years.Conclusions Urachal carcinoma is difficult to be diagnosed due to its special anatomical position.Most of the patients were diagnosed at late stage and had relatively poor prognosis.The most important prognostic factor is the clinical stage.Extensive partial cystectomy might be one of the best treatments for the disease.Radical removal of the tumor during the first treatment and comprehensive therapies for advanced cancer patients and patients with recurrence or metastasis after operation are critical to improve the treatment efficacy of urachal carcinoma.