本文選題：膀胱癌 + 前列腺侵犯　； 參考：《昆明醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：通過對(duì)膀胱癌侵犯前列腺及精囊的危險(xiǎn)因素研究,為保留前列腺及精囊的根治性膀胱切除術(shù)的開展尋找臨床依據(jù)。 方法：收集2013年5月至2014年4月,在昆明醫(yī)科大學(xué)第二附屬醫(yī)院接受開放或腹腔鏡根治性膀胱切除術(shù)的78例男性膀胱癌患者的病理資料。對(duì)根治術(shù)后的膀胱、前列腺標(biāo)本進(jìn)行系統(tǒng)病理切片檢查,前列腺標(biāo)本病理切片采用每間隔5mm做多個(gè)冠狀切面至前列腺尖部。通過對(duì)患者根治性膀胱切除后標(biāo)本的病理研究,即患者的年齡、腫瘤的數(shù)目、分級(jí)、分期、大小、部位、腫瘤距膀胱頸口的最近距離及是否有淋巴結(jié)轉(zhuǎn)移,分析上述危險(xiǎn)因素與前列腺和精囊受侵犯的相關(guān)性。 結(jié)果：78例膀胱癌患者的平均年齡為61.23±11.46歲,9例(11.5%)前列腺被膀胱癌侵犯,3例(3.85%)侵犯精囊,13例(16.7%)發(fā)現(xiàn)偶發(fā)前列腺腺癌。膀胱癌侵犯前列腺的危險(xiǎn)因素經(jīng)統(tǒng)計(jì)學(xué)分析,結(jié)果得出膀胱腫瘤部位、腫瘤距膀胱頸口的最近距離、腫瘤分級(jí)、腫瘤分期、淋巴轉(zhuǎn)移情況等指標(biāo)有統(tǒng)計(jì)學(xué)意義(P0.05),而年齡、腫瘤大小、腫瘤數(shù)目則無統(tǒng)計(jì)學(xué)意義(P0.05)。腫瘤位于膀胱三角區(qū)或頸部、多發(fā)腫瘤、腫瘤直徑大于4cm、淋巴結(jié)陽性是膀胱腫瘤侵犯精囊的危險(xiǎn)因素。13例膀胱癌伴偶發(fā)前列腺腺癌的患者的Gleason評(píng)分均小于7分,且僅在病理切片中發(fā)現(xiàn)微小或局灶區(qū)域的高分化前列腺腺癌,其危險(xiǎn)因素為高齡和分期高的膀胱癌(P0.05)。 結(jié)論：1、腫瘤位于膀胱頸部或三角區(qū)、腫瘤距膀胱頸口的距離較近、高分級(jí)、T3期以上的腫瘤以及淋巴陽性是膀胱腫瘤侵犯前列腺的高危因素。 2、腫瘤位于膀胱三角區(qū)或頸部、多發(fā)腫瘤、腫瘤直徑大于4cm、淋巴結(jié)陽性是膀胱腫瘤侵犯精囊的危險(xiǎn)因素。 3、膀胱腫瘤患者的年齡及T2期以上的腫瘤是偶發(fā)前列腺癌的危險(xiǎn)因素。 4、為了保證手術(shù)后的效果,在實(shí)施保留前列腺的根治性膀胱切除術(shù)時(shí)應(yīng)進(jìn)行嚴(yán)格篩選,可將年齡相對(duì)較小、腫瘤不位于膀胱頸部或三角區(qū)、距離膀胱頸口較遠(yuǎn)、腫瘤直徑小于4cm、T2期以下的腫瘤、低分級(jí)和淋巴結(jié)陰性作為實(shí)施保留前列腺的根治性膀胱切除術(shù)的適應(yīng)證。
[Abstract]:Objective: to study the risk factors of bladder cancer invasion of prostate and seminal vesicle, and to find the clinical basis for radical cystectomy for preserving prostate and seminal vesicle. Methods: from May 2013 to April 2014, 78 male patients with bladder cancer underwent open or laparoscopic radical cystectomy in the second affiliated Hospital of Kunming Medical University. The specimens of bladder and prostate after radical operation were examined by systematic pathological sections. The 5mm sections were used to make multiple coronal sections to the apex of the prostate. After radical cystectomy, the patient's age, tumor number, grade, stage, size, location, the nearest distance from the bladder neck and lymph node metastasis were studied. To analyze the correlation between the above risk factors and the invasion of prostate and seminal vesicle. Results the average age of 78 patients with bladder cancer was 61.23 鹵11.46 years old (9 / 78) (11.5%). The prostate was invaded by bladder cancer in 3 cases (3.85%) and the seminal vesicle in 13 cases (16.7%). The risk factors of bladder cancer invading the prostate were statistically analyzed. The results showed that the location of bladder tumor, the closest distance from the tumor to the bladder neck, tumor grade, tumor stage, lymphatic metastasis and so on were statistically significant (P0.05). Tumor size and tumor number were not statistically significant (P0.05). The tumor was located in the trigonometry or neck of the bladder with multiple tumors. The diameter of the tumor was more than 4 cm. The positive lymph node was the risk factor of bladder tumor invading seminal vesicle. The Gleason score of 13 cases of bladder cancer with incidental prostate adenocarcinoma was less than 7 points. Only small or focal areas of well-differentiated prostate adenocarcinoma were found in pathological sections, and the risk factors were advanced bladder cancer (P0.05). Conclusion the tumor is located in the neck or triangle of the bladder, and the distance from the tumor to the neck of the bladder is close. High grade T 3 tumor and lymphatic positive are the high risk factors of bladder tumor invading the prostate. 2. The tumor is located in the triangle or neck of the bladder, and has multiple tumors. The diameter of tumor is more than 4 cm, the positive lymph node is the risk factor of bladder tumor invading seminal vesicle. 3. The age of bladder tumor patients and the tumor over T2 stage are the risk factors of incidental prostate cancer. After the operation, When performing radical cystectomy to preserve the prostate, strict screening should be carried out. Tumors with a relatively young age, which are not located in the neck or triangle of the bladder, are farther away from the neck of the bladder, and the diameter of the tumor is less than 4 cm or below T2. Low grade and negative lymph nodes are indications for prostate-preserving radical cystectomy.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.14

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