膀胱癌膀胱全切术后尿道复发的风险评估及对策

目的 探讨膀胱癌膀胱全切术后尿道复发的危险因素及处理方法。方法 回顾分析278例膀胱癌膀胱全切患者的临床资料，其中24例发生了尿道复发。运用cox’s多因素回归模型对影响复发的危险因素进行评价。结果 6例选择性尿道切除者无1例死于肿瘤；24例尿道复发者10例死于肿瘤转移。多因素分析表明前列腺受累、膀胱颈受累、三角区肿瘤、多发肿瘤和原位癌是影响尿道复发的危险因素，相对危险度分别为1．573，1．532，1．360，1.337和1．213。结论 前列腺受累、膀胱颈受累、三角区肿瘤、多发肿瘤或原位癌是预防性尿道切除术的指征。保留尿道的患者宜尽量行正位排尿的尿流改道术。

Risk factors of urethral recurrence following radical cystectomy for bladder cancer patients and ma-nagement of urethra

Objective To evaluate the risk factors of urethral recurrences following radical cystectomy for transitional cell carcinoma of the bladder and to discuss the treatment options. Methods Clinical data of 278 patients who underwent radical cystectomy for bladder cancer were analyzed retrospectively. Urethral recurrences were observed in 24 patients. Risk factors of recurrence were evaluated by Cox's multifactor regression model. Results None of the 6 patients undergoing selective prophylactic urethrectomy died;10 of the 24 patients with urethral recurrence died of tumor metastasis.Multiple factor analysis suggested that prostate involvement,bladder neck involvement,trigone tumor,multiple tumor and carcinoma in situ were the high risk factors,and their relative risk coefficients were 1.573,1.532,1.360, 1.337 and 1.213,respectively. Conclusions Simultaneous urethrectomy following radical cystectomy should be performed for patients with high risk factors (prostate involvement, bladder neck involvement, trigone tumor,multiple tumor and carcinoma in situ) of urethral recurrence,while patients without risk factors are eligible candidates for reconstruction of the urinary tract after cystectomy by an orthotopic neobladder.