膀胱部分切除术联合放化疗治疗肌层浸润性膀胱癌的研究

目的总结我院采用膀胱部分切除术联合放化疗治疗肌层浸润性膀胱癌的经验。方法回顾性分析27例接受膀胱部分切除联合放化疗的肌层浸润性膀胱癌患者的临床资料。男20例、女7例,中位年龄51岁。96%（26/27）的患者肿瘤位于膀胱侧壁、前壁或顶部,81%（22/27）的患者肿瘤单发,肿瘤平均直径2.3cm,手术切缘1.3～2.0cm。病理分期为T2期14例、T3期11例、T4期2例,病理分级为G12例、G210例、G315例。尿路上皮癌25例、鳞癌1例、腺癌1例。膀胱部分切除术中用羟基喜树碱浸泡膀胱及切口,6例行新辅助治疗,其中同步放化疗2例、髂动脉导管化疗4例,辅助化疗19例、辅助放疗2例,27例患者均接受膀胱灌注化疗。结果 27例患者外科切缘均为阴性,无切口种植。6例新辅助治疗的患者总反应率为66.7%。本组25例患者获得随访,中位随访期为80个月,7例局部复发,其中4例行挽救性全膀胱切除术,11例死亡,7例无瘤生存,患者5年生存率为56%。结论选择合适的肌层浸润性膀胱癌患者,采取膀胱部分切除联合放化疗可取得较为满意的疗效。

Partia lcystectomy combined with chemotherapy and radiotherapy for muscle invasive bladder carcinoma Urology

Objective To summary the experience of multimodal treatment of partial cystectomy combined with chemotherapy and radiotherapy for muscle invasive bladder carcinoma at Cancer Hospital of Chinese Academy of Medical Science.Methods We retrospectively reviewed clinical data of 27 patients with muscle invasive bladder carcinoma treated with partial cystectomy and chemotherapy and/or radiotherapy.20 men and 7 women were identified with a median age of 51 years.Tumors of 96%（26/27） patients were located at bilateral or anterior wall or dome of bladder.81% percent（22/27） were single tumor.The average diameter of tumors were 2.3 cm.The cutting edges were 1.3-2.0 cm.14 patients had pathological stage-in T2,11 in T3,and 2 in T4.2 were grade 1,10 were grade 2,and 15 were grade 3.25 case were urothelium carcinoma,1 case squamous carcinoma and 1 was adenocarcinoma.Hydroxy camptothecin was used to dip bladder and wound.6 cases had neoadjuvant treatment in which 2 had radiation and concurrent chemotherapy and 4 had intra-arterial chemotherapy.19 patients had adjuvant chemotherapy and 2 adjuvant radiation.All patients in our series were given intravesical chemotherapy.Results The surgical margins of all 27 cases were negative.No wound recurrences were seen in our series.The response rate was 66.7% of 6 patients who had neoadjuvant therapy.25 patients were followed up.The mean follow-up was sixty months.7 cases had recurrence and 4 had salvage radical cystectomy.11 cases died.The overall 5-year survival rate was 56% of our series.Conclusions Partial cystectomy combined with chemotherapy and radiotherapy can obtain satisfactory effect in muscle invasive bladder carcinoma with carefully selected patients.