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.

Urachal carcinoma:clinicopathologic features and surgical outcomes

Objective To discuss the clinical and pathological features of urachal carcinoma.Methods The clinical and pathological data of 7 patients diagnosed as urachal carcinoma were retrospectively analyzed,and the cIinicopathologic features,diagnosis and treatment,surgical characteristics and surgical outcomes were reviewed.There were 6 males and 1 female.Patient's age ranged from 26-75 years,with average of 52 years.Examinations before surgery included ultrasound,cystoscopy,urine cytology,CT and IVU.Six patients underwent extensive partial cystectomy and 1 patient underwent conventional partial cystectomy. Results Pathological diagnosis were 5 cases of mucinous adenocarcinoma,1 case of not classified adenocarcinoma,1 case of small cell neuroendocrine carcinoma.Clinical stages according to Sheldon staging system were 6 cases of stage ⅢA and 1 case of ⅢC.One patient died of bone metastasis 3 months after operation,1 patient experienced recurrence in bladder neck and urethra in 15 months and 24 months after operation and received TUR-Bt,the other 5 patients were alive without recurrence and metastasis with follow-up of 2-30 months. Conclusion Urachal carcinoma is a rare malignancy,and patients with this disease haye a poor prognosis.