本文選題：臍尿管癌 + 手術(shù)�。� 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的:介紹腹腔鏡臍尿管癌手術(shù)切除的可行性及臨床療效。材料、方法:回顧性分析山東大學(xué)附屬省立醫(yī)院自2008年1月～2014年1月,對(duì)21例平均年齡53±12.6歲(23～76歲),腫瘤最大徑平均4.0±1.5cm(2.1～7.4cm)的臍尿管癌患者采用開放式或腹腔鏡切除術(shù)。其中2例Sheldon分期Ⅱ期,其余19例屬Sheldon分期Ⅲ期,均為ⅢA期。手術(shù)切除范圍包括:臍尿管所有殘留結(jié)構(gòu)包含與其相連的腹橫筋膜和腹膜,膀胱頂壁(臍尿管腫物及其周圍2cm的正常膀胱壁)。記錄手術(shù)時(shí)間、出血量、術(shù)中是否輸血、手術(shù)后病理結(jié)果、拔除腹腔引流管時(shí)間、拔除導(dǎo)尿管時(shí)間、圍手術(shù)期相關(guān)并發(fā)癥及住院天數(shù)。17例術(shù)后行GC方案化療3個(gè)療程。術(shù)后患者定期復(fù)查胸部、全腹部及盆腔強(qiáng)化CT、膀胱鏡并隨訪復(fù)發(fā)情況及生存時(shí)間,中位隨訪時(shí)間36個(gè)月(5～61個(gè)月)。結(jié)果:本組21例患者中6例行開放性手術(shù)。其余15例均行腹腔鏡手術(shù),無中轉(zhuǎn)開放手術(shù)。開放手術(shù)組平均手術(shù)時(shí)間98.3±26.4分鐘(60～130分鐘),手術(shù)中平均估計(jì)出血量60±20ml(50～100ml),術(shù)中均無輸血,腹腔引流管平均留置8.5±4.0天(5～14天),術(shù)后平均留置導(dǎo)尿管10.5±3.7天(6～13天),均未出現(xiàn)尿漏,術(shù)后2～3天可進(jìn)流質(zhì)飲食,平均住院時(shí)間11.5±3.7天(7～14天)。腹腔鏡手術(shù)組平均手術(shù)時(shí)間100.7±30.6分鐘(50～160分鐘),手術(shù)中平均估計(jì)出血量49.3±29.4ml(20～100ml),術(shù)中均無輸血,腹腔引流管平均留置時(shí)間6.5±2.9天(3～13天),術(shù)后平均留置導(dǎo)尿管10.8±3.8天(6～18天),均未出現(xiàn)尿漏,術(shù)后2～3天可進(jìn)流質(zhì)飲食,平均住院時(shí)間11.8±3.8天(7～19天)。術(shù)后病理結(jié)果:臍尿管非囊性腺癌19例(19/21),其中:粘液型腺癌11例(11/19),腸型腺癌6例(6/19),腸型腺癌及粘液型腺癌混合者2例(2/19)。另有粘液囊腺癌1例,混合癌1例。病理切緣均為陰性,由于術(shù)前影像學(xué)檢查未提示存在盆腔淋巴結(jié)轉(zhuǎn)移,且腫瘤均未累及腹壁、腹膜,故21例患者均未行淋巴結(jié)清掃或臍部切除。術(shù)中及術(shù)后并發(fā)癥情況:1名患者術(shù)后7天訴左小腿疼痛,急查D二聚體(D-dimer)5.85ng/ml,雙下肢血管彩超示左小腿肌間靜脈血栓,給予抗凝治療后好轉(zhuǎn),余患者均恢復(fù)順利。中位隨訪時(shí)間36個(gè)月(5～61個(gè)月),其中1年總體生存率(overall survival,OS)為 76.19%(16/21),疾病特異性生存率(disease specific survival,DSS)為85.7%(18/21),2 年 OS 為 66.67%(14/21),DSS 為 81.0%(17/21),3 年OS 為57.14%(12/21),DSS 為 81.0%(17/21)。結(jié)論:臍尿管癌臨床發(fā)病率低,病因尚未明確,其最常見病理類型為腺癌。臍尿管癌惡性程度高,預(yù)后較差,但常由于該疾病癥狀隱匿使得早期發(fā)現(xiàn)、診斷變得困難。常見首發(fā)癥狀多為肉眼血尿或尿頻、尿急、尿痛等排尿刺激征,也可見恥骨上疼痛、肉眼粘液性尿,極少數(shù)患者因可觸及的孤立性腹部包塊就診。確診時(shí)多數(shù)患者已經(jīng)出現(xiàn)了膀胱浸潤(rùn)。針對(duì)臍尿管癌的治療目前尚無統(tǒng)一的指南,手術(shù)治療是臍尿管癌首選治療辦法,腹腔鏡膀胱部分切除手術(shù)(laparoscopic partial cystectomy,LPC)與開放手術(shù)或膀胱根治性切除手術(shù)相比預(yù)后相當(dāng)。LPC用于治療臍尿管癌具有圍術(shù)期短、失血少、刀口美觀、創(chuàng)傷小、術(shù)后并發(fā)癥少等優(yōu)勢(shì),手術(shù)中應(yīng)注意防止腫瘤擴(kuò)散。腫瘤的分期早及術(shù)后病理切緣陰性的臍尿管癌預(yù)后相對(duì)較好。而淋巴結(jié)清掃和其他輔助治療對(duì)于生存率的影響尚不明確。相對(duì)于開放手術(shù),LPC是一種更加安全,值得推廣的治療方法。
[Abstract]:Objective: to introduce the feasibility and clinical effect of laparoscopic urachal carcinoma resection. Materials and methods: a retrospective analysis of 21 cases of urachal cancer with an average age of 53 + 12.6 years (23~76 years) and an average of 4 + 1.5cm (2.1 ~ 7.4CM) 1.5cm (2.1 ~ 7.4CM) with an open or laparoscopy from January 2008 to January 2014 in the affiliated Provincial Hospital of the Affiliated Hospital of Shandong University was reviewed. Excision. 2 cases of Sheldon staging stage II, the other 19 cases were stage III of Sheldon stage III, stage III A. The surgical excision range includes: all residual structures of urachus include the abdominal transverse fascia and peritoneum, the top wall of the bladder (urachal mass and the normal bladder wall around 2cm). Postoperative pathological results, extraction of abdominal drainage tube time, extraction of catheter time, perioperative complications and the number of days of hospitalization.17 after 3 courses of chemotherapy GC regimen. Postoperative patients regularly review the chest, abdominal and pelvic enhanced CT, cystoscopy and follow-up and survival time, median follow-up time of 36 months (5~61 months). Fruit: 6 of the 21 patients in this group were operated on open surgery. The remaining 15 cases were performed laparoscopy without open operation. The average operation time of the open operation group was 98.3 + 26.4 minutes (60~130 minutes). The average estimated bleeding was 60 + 20ml (50 ~ 100ml) during the operation. There was no blood transfusion during the operation, and the average retention of the abdominal drainage tube was 8.5 + 4 days (5~14 days), and the postoperative level was flat. The urethral catheter was retained for 10.5 + 3.7 days (6~13 days), and no urinary leakage was found. The average hospitalization time was 11.5 + 3.7 days (7~14 days) 2~3 days after the operation. The average operation time of the laparoscopic operation group was 100.7 + 30.6 minutes (50~160 minutes). The average estimated bleeding was 49.3 29.4ml (20 ~ 100ml) during the operation. There was no blood transfusion in the operation, and Guan Ping was drained in the abdominal cavity. The average retention time was 6.5 + 2.9 days (3~13 days). The average indwelling catheter was 10.8 + 3.8 days (6~18 days) after the operation. No urinary leakage was found. The intake of the fluid was not found on 2~3 days after the operation. The average hospitalization time was 11.8 + 3.8 days (7~19 days). The postoperative pathological results were 19 (19/21) of urachal non cystic adenocarcinoma, including mucinous adenocarcinoma 11 cases (11/19) and intestinal adenocarcinoma 6 cases (6/19). There were 2 cases of intestinal adenocarcinoma and mucous adenocarcinoma (2/19). There were 1 cases of mucinous cystadenocarcinoma and 1 cases of mixed carcinoma. The pathological margins were all negative. There were no pelvic lymph node metastases in the preoperative imaging examination, and no abdominal wall and peritoneum were involved in all 21 patients. Intraoperative and postoperative complications were not performed. 7 days after operation, 1 patients complained of left calf pain, D two polymer (D-dimer) 5.85ng/ml, double leg blood vessel color Doppler ultrasound in left calf intermuscular venous thrombosis, after anticoagulation treatment improved, the remaining patients recovered smoothly. The median follow-up time was 36 months (5~61 months), and the total survival rate of 1 years (overall survival, OS) was 76.19% (16/21), disease specificity. The survival rate (disease specific survival, DSS) was 85.7% (18/21), OS was 66.67% (14/21), DSS was 81% (17/21), 3 year OS was 57.14% (12/21) and DSS was 81%. Conclusion: the clinical incidence of urachus cancer is low, the etiology is not clear, the most common pathological type is adenocarcinoma. Urachus cancer is highly malignant and poor prognosis, but often due to this Insidious symptoms of the disease make it difficult to find early diagnosis. The common onset symptoms are mostly hematuria or frequency of urine, urination, urine pain and other urination irritation, as well as suprapubic pain, mucous urine, and very few patients with palpable isolated abdominal mass. Most patients have had bladder infiltration at the time of diagnosis. There are no unified guidelines for the treatment of carcinoma of the tube. Surgical treatment is the first choice for urachal carcinoma. Laparoscopic partial cystectomy (laparoscopic partial cystectomy, LPC) is quite.LPC compared to open surgery or radical resection of the bladder for the treatment of umbilical cord carcinoma with short perioperative period, less bleeding, beautiful knife mouth and trauma. Small, less postoperative complications, attention should be paid to the prevention of tumor diffusion. The prognosis of urachus cancer with early stage and postoperative pathological margin is relatively good. The effect of lymph node dissection and other adjuvant therapy on the survival rate is not clear. Compared with open surgery, LPC is a safer and worth popularizing treatment.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.1

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