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  本文選題：肌層浸潤性膀胱癌 + 根治性膀胱切除術�。� 參考：《青島大學》2014年碩士論文

【摘要】：目的 探討保留膀胱手術結(jié)合放化療在肌層浸潤性膀胱癌(MIBC)治療中的價值。 方法 收集我院2003年1月至2010年8月MIBC病例72例,根據(jù)治療方式,其中保留膀胱組42例,根治性膀胱切除組30例。保留膀胱組采用膀胱部分切除(PC)或經(jīng)尿道膀胱腫瘤切除(TURBT);28例采用膀胱部分切除,14例采用TURBT,所有保留膀胱的病人均完成化療；其中5例因腫瘤未完全切除或切緣陽性放療。通過住院病歷、門診及電話等方式隨訪,應用Kaplan-meier法和Log-rank檢驗,比較2組生存情況。 結(jié)果 72例肌層浸潤性膀胱癌,男54例,女18例,平均年齡67.3歲(40-85歲),隨訪病人56例,隨訪率78%�；颊唠S訪12-92個月,平均隨訪43.1個月,中位隨訪時間為50個月。保留膀胱組腫瘤局部復發(fā)共24例,其中非肌層侵潤性復發(fā)16例,肌層侵潤性復發(fā)8例。6例肌層侵潤性復發(fā)再次行TURBT或膀胱部分切除,結(jié)合放化療治療。1例行挽救性膀胱癌根治術。1例因遠處轉(zhuǎn)移行姑息性TURBT。隨訪期間,死于膀胱癌者34例,保留膀胱組21例(50%),根治性膀胱切除組13例(43%)；死于非膀胱腫瘤者2例。保留膀胱組生存時間均數(shù)為50.721月,中位數(shù)為47月；根治性膀胱切除組生存時間為57.540月,中位數(shù)為52月。術后1、2、3、4、5年生存率保留膀胱組分別為88.1%、83.3%、61.9%、57.1%、47.6%,根治性膀胱切除組分別為86.7%、80.0%、66.7%、63.6%、53.3%。經(jīng)Kaplan-Meier分析提示兩組生存時間無統(tǒng)計學差異(P=0.7590.05)。 結(jié)論 1、MIBC采取保留膀胱的綜合治療可達到與根治性膀胱切除相似的生存率。 2、對拒絕或身體條件差不能耐受膀胱根治性切除的MIBC患者,保留膀胱的綜合治療是一種合理的治療方式。
[Abstract]:Objective to investigate the value of bladder preserving surgery combined with radiotherapy and chemotherapy in the treatment of myometrial invasive bladder cancer (MIBC). Methods from January 2003 to August 2010, 72 cases of MIBC in our hospital were collected. According to the treatment methods, 42 cases were in bladder preserving group and 30 cases in radical cystectomy group. Cystectomy (PC) or transurethral resection of bladder neoplasms (TURBT) were performed in 28 patients with cystectomy (PC) or transurethral resection of bladder tumor (TURBT). Kaplan-meier method and Log-rank test were used to compare the survival of the two groups. Results 72 cases (54 males and 18 females, mean age 67.3 years (40-85 years) were followed up in 72 cases (54 males and 18 females). 56 cases were followed up and the follow-up rate was 78g%. Patients were followed up for 12-92 months with an average of 43.1 months, with a median follow-up time of 50 months. There were 24 cases of local recurrence of tumor in bladder retention group, including 16 cases of non-muscular invasion recurrence, and 8 cases of muscular invasion recurrence. 6 cases of muscle invasion recurrence were treated with TURBT or partial cystectomy again. Combined with radiotherapy and chemotherapy, 1 cases of radical resection of salvage bladder cancer were treated with palliative TURBT due to distant metastasis. During the follow-up period, 34 cases died of bladder cancer, 21 cases (50%) died of bladder preservation, 13 cases (43%) died of radical cystectomy, and 2 cases died of non-bladder tumor. The mean survival time of bladder retention group was 50.721 months, the median was 47 months, and that of radical cystectomy group was 57.540 months, the median was 52 months. The 4 and 5 year survival rates in the bladder retention group were 88.1and 83.3, respectively, and 57.1% and 47.6%, respectively, in the radical cystectomy group, 86.7% and 63.6% in the radical cystectomy group, respectively, and 53.3% in the radical cystectomy group. Kaplan-Meier analysis showed that there was no significant difference in survival time between the two groups (P0. 7590.05). Conclusion (1) the survival rate of MIBC treated with bladder retention is similar to that of radical cystectomy. 2. MIBC patients who refuse or have poor physical condition can not tolerate radical cystectomy. Bladder retention therapy is a reasonable treatment.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.14

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本文編號：2071017