根治性膀胱切除原位回肠新膀胱术后尿道肿瘤复发的原因及治疗

目的：探讨膀胱尿路上皮癌行根治性膀胱切除原位回肠新膀胱术后尿道复发的原因及治疗方法。方法：回顾403例膀胱尿路上皮癌行根治性膀胱切除原位回肠新膀胱术的患者资料，总结尿道肿瘤的复发率、原凼、诊断、治疗和预后。结果：6例患者出现尿道肿瘤复发，复发率为1．5％，均为男性。2例浸润性尿道肿瘤和1例尿道广泛表浅性乳头状瘤行全尿道切除术和新膀胱造瘘术，3例尿道表浅性乳头状瘤行经尿道肿瘤切除术和尿道内灌注化疗，术后2例复发，再次行全尿道切除术。2例浸润性尿道肿瘤和1例尿道广泛表浅性乳头状瘤在2年内因肿瘤复发或转移死亡。结论：膀胱多发原位癌、肿瘤侵犯前列腺尿道和基质、女性膀胱颈部是尿道复发主要原因。原位新膀胱的尿道复发率低于其他尿流改道术，全尿道切除术是尿道复发更可靠的治疗方案，尿道表浅性肿瘤的预后明显好于浸润性肿瘤。

Causes and management of urethral recurrence following radical cystectomy with orthotopic ileal neobladder

Objective： To evaluate the incidence, causes and management of urethral recurrence（UR） following radical cystectomy（RC） with orthotopic ileal neobladder. Method： The records of 403 patients treated with RC and orthotopic ileal neobladder due to bladder urothelial carcinoma（BUC） were reviewed retrospectively. The inci dence, causes clinical presentation, diagnosis, treatment and evolution of UR were evaluated. Result： All six pa tients （1.5%） with UR were male. Two patients with invasive urethral tumor and one patient with extensive superficial tumor were performed urethrectomy and neobladder fistulation. Transurethral resection and intraurethral chemotherapy were administered in three cases with superficial UR, but two recurred and received urethrectomy. Two patients with invasive tumor and one patient with extensive superficial tumor died of local recurrence and metastatic disease within two years. Conclusion： Bladder carcinoma in situ, prostatic urethral and stromal involvement, and bladder neck involvement in female are significantly associated with UR following RC. Incidence of UR of orthotopic diversion is much lower than that of cutaneous diversion. Urethrectomy is a more reliable treatment for UR. Patients with superficial UR have significantly better survival than patients with invasive tumor.