保留膀胱手术治疗肌层浸润性膀胱癌临床分析

目的:探讨肌层浸润性膀胱癌(muscle invasive bladder cancer,MIBC)行保留膀胱手术治疗的可行性及临床价值。方法:回顾性分析43例MIBC患者的临床资料:男28例,女15例,年龄45～88岁,平均62岁。其中38例(88.4%)行经尿道膀胱肿瘤电切除术(transurethral resection of bladder tumor,TURBT),5例(11.6%)行膀胱部分切除术;术后均行膀胱灌注化疗或放疗。结果:术后病理分期:T236例(83.7%),T37例(16.3%);病理分级:G14例(9.3%),G231例(72.1%),G38例(18.6%)。术后随访6～126个月,平均63.2个月;首次复发为3～20周,平均10.2周,复发次数1～8次,平均3.7次;共行2～9次TURBT,平均3.5次,其中25例(58.1%)于≥3次TURBT后出现病理性进展,9例(20.9%)于术后复发次数≥3次后改行根治术;2例(4.7%)死于非膀胱癌疾病,1例(2.3%,病理为T2G1)于首次术后126个月死于膀胱癌多发转移。结论:对于MIBC,可选择性行以TURBT为主加放化疗的保留膀胱手术治疗,但具有反复复发及进展倾向;首次复查膀胱镜时间需提前到术后4～8周,远期疗效需进一步评估。

Surgical bladder preserving strategies for muscle-invasive bladder cancer

Objective:To study the clinical value of bladder-preserving strategies for muscle invasive bladder cancer(MIBC).Methods:The data from 43 patients(28 men,15 women) with bladder-preserving operations for MIBC were retrospectively reviewed.Their age ranged from 45 to 88 years with a mean of 62 years.Of 43 patients,38(88.4%) and 5(11.6%) experienced transurethral resection of bladder tumor(TURBT) and partial cystectomy,all were performed systemic intravesical chemotherapy or radiotherapy post-operation.Results:The pathologic stage and grade of the initial MIBC were distributed as follows: 36(83.7%) patients had pT2 tumors,7(16.3%) had pT3;4(9.3%) had G1 tumors,31(72.1%) had G2,and 8(18.6%) had G3.During a mean of 63.2 months(range 6 to 126) follow-up,the mean times of intravesical recurrence and total TURBT were 3.7(range one to 8) and 3.5(range 2 to 9),respectively.After first operations,patients suffered from first intravesical recurrence in a mean of 10.2 weeks(range 3 to 20).Of these 43 patients,25(58.1%) developed more poorly differentiated tumors with more than 3 times of TURBT,9(20.9%) experienced radical cystectomy with more than 3 times intravesical recurrence,1(2.3%) with T2G1 tumors died of MIBC with metastasis in 126 months,2(4.7%) died of other diseases.Conclusions:For strictly selective patients with MIBC,TURBT combined systemic chemotherapy and radiation therapy were an alternatives to standard radical surgery.However,the initial cystoscopy was suggested to perform at 4 to 8 weeks post-operation,and the role of those alternatives require further investigation.