【摘要】：目的:通過分析膀胱癌患者在行經(jīng)尿道膀胱腫瘤電切術(shù)后,經(jīng)過病理診斷為肌層浸潤性膀胱癌且拒絕行根治性膀胱全切術(shù)的治療效果及預(yù)后,為肌層浸潤性膀胱癌患者的診療方案提供新的思路。方法:通過回顧性分析2011年1月至2015年12月于我院行經(jīng)尿道膀胱腫瘤電切術(shù)(TURBT)治療后,其病理診斷為肌層浸潤性膀胱癌,并且拒絕行根治性膀胱全切術(shù)的患者110例,其中包括男性79例,女性31例。年齡38-89歲,平均年齡67.3歲,手術(shù)時完整切除腫瘤,深度達(dá)膀胱壁外脂肪層,范圍至膀胱腫瘤周圍0.5-1.0cm正常粘膜。術(shù)后105例患者進(jìn)行膀胱灌注治療,其中10例同時進(jìn)行GC方案4周期的全身輔助化療,5例行髂內(nèi)動脈栓塞化療術(shù),另有5例術(shù)后失訪。結(jié)果:在本組110例患者行膀胱腫瘤電切術(shù),手術(shù)順利,手術(shù)平均時間43min;術(shù)中出血量平均15ml,所有手術(shù)均未出現(xiàn)嚴(yán)重并發(fā)癥;患者術(shù)后住院時間平均7.7天。術(shù)后成功隨訪患者105例,均進(jìn)行了膀胱灌注治療,其中10例進(jìn)行GC方案4周期的全身化療,5例行髂內(nèi)動脈栓塞化療術(shù)。術(shù)后復(fù)發(fā)28例,復(fù)發(fā)率26.7%,復(fù)發(fā)時間1-62個月,平均復(fù)發(fā)時間20.6個月。復(fù)發(fā)后行經(jīng)尿道膀胱腫瘤電切術(shù)治療18例,行膀胱部分切除術(shù)+GC方案+盆腔局部放療1例,行膀胱全切術(shù)7例,保守治療2例。隨訪時間不少于2年的患者有78例,復(fù)發(fā)21例,復(fù)發(fā)率26.9%,平均復(fù)發(fā)時間25.0月。至末次隨訪時間,共生存102例,3例患者死亡,其中1例因膀胱癌復(fù)發(fā)轉(zhuǎn)移去世,1例因胃癌晚期轉(zhuǎn)移死亡;1例患者于術(shù)后12個月死亡,原因不詳。結(jié)論:對于拒絕行根治性膀胱全切的肌層浸潤性膀胱癌患者,經(jīng)尿道膀胱腫瘤電切術(shù)是一種行之有效的治療方法,手術(shù)創(chuàng)傷小,恢復(fù)快,并發(fā)癥少,手術(shù)后患者生活質(zhì)量有保障。對于保留膀胱的患者,在經(jīng)尿道膀胱腫瘤電切術(shù)(TURBT)后需要定期復(fù)查并結(jié)合膀胱灌注及輔助化療,可以達(dá)到較理想的效果。
[Abstract]:Objective: to analyze the therapeutic effect and prognosis of patients with bladder cancer who were diagnosed as invasive bladder cancer by pathology and refused to undergo radical cystectomy after transurethral resection of bladder tumor. It provides a new idea for the diagnosis and treatment of intramuscular invasive bladder cancer. Methods: from January 2011 to December 2015, 110 patients with invasive bladder cancer were diagnosed pathologically and refused to undergo radical cystectomy after transurethral resection of bladder tumor (TURBT). There were 79 males and 31 females. The average age was 67.3 years (38 / 89 years). The tumor was excised completely at the time of operation, reaching the depth of the extramural fat layer of the bladder and extending to the normal 0.5-1.0cm mucosa around the bladder tumor. Postoperative intravesical perfusion therapy was performed in 10 patients, including 10 patients with GC regimen for 4 cycles of systemic adjuvant chemotherapy, 5 patients with internal iliac artery chemotherapy and 5 patients with postoperative loss of follow-up. Results: 110 patients underwent electroresection of bladder tumors with an average operation time of 43 minutes, an average intraoperative blood loss of 15 ml, no serious complications, and an average postoperative hospital stay of 7.7 days. After operation, 10 patients were treated with intravesical instillation, 10 patients were treated with 4 cycles of systemic chemotherapy with GC regimen, 5 patients were treated with embolization of internal iliac artery. There were 28 cases of recurrence, the recurrence rate was 26.7%, the recurrence time was 1 鈮，

本文編號：2474205