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目的探讨膀胱非尿路上皮癌的发病特点,总结其诊治经验。方法回顾分析2001年1月至2009年12月收治的59例膀胱非尿路上皮癌的临床资料。其中男37例,女22例,平均年龄72.6岁;临床主要表现为无痛性肉眼血尿和膀胱刺激症状;辅助检查包括B超、盆腔CT及膀胱镜检+活检。另选同期膀胱尿路上皮癌51例作为对照。比较两组患者围手术期治疗,术后1、3和5年生存率等差异。结果 59例膀胱非尿路上皮癌患者,术后病理检查证实膀胱腺癌13例、膀胱鳞癌10例、膀胱小细胞癌5例、膀胱平滑肌肉瘤2例、副神经节瘤4例和混合癌肿25例。其中行全膀胱切除术41例,膀胱部分切除术6例,经尿道膀胱肿瘤电切术(TUBRT)12例。术前新辅助治疗4例,术后辅助放疗14例,术后辅助化疗35例。有效随访53例,术后1、3和5年生存率分别为83.1%、54.7%和28.3%。51例膀胱尿路上皮癌术后均经病理证实诊断,其中行全膀胱切除术12例,膀胱部分切除术3例,TUBRT36例。术后成功随访43例,术后1、3和5年生存率分别为81.8%、76.7%和72.7%。结论膀胱非尿路上皮癌临床少见,恶性程度较高,预后较差。根治性膀胱全切除术是首选手术方法,结合不同肿瘤类型的病理特点,辅助或新辅助放、化疗可望提高疗效。
Objective To investigate the incidence of bladder urothelial carcinoma and summarize its experience of diagnosis and treatment. Methods The clinical data of 59 cases of bladder urothelial carcinoma admitted from January 2001 to December 2009 were retrospectively analyzed. There were 37 males and 22 females, with an average age of 72.6 years. The main clinical manifestations were painless gross hematuria and bladder irritation. Auxiliary examinations included B-mode ultrasound, pelvic CT and biopsy. In the same period, 51 cases of bladder urothelial carcinoma as control. The perioperative treatment, survival rates at 1, 3, and 5 years after operation were compared between the two groups. Results Of the 59 patients with bladder urothelial carcinoma, postoperative pathological examination confirmed 13 cases of cystadenocarcinoma, 10 cases of bladder squamous cell carcinoma, 5 cases of bladder small cell carcinoma, 2 cases of bladder leiomyosarcoma, 4 cases of paraganglioma, Swollen in 25 cases. There were 41 cases underwent total cystectomy, 6 cases underwent partial cystectomy and 12 cases underwent transurethral resection of bladder tumor (TUBRT). Preoperative neoadjuvant treatment in 4 cases, postoperative adjuvant radiotherapy in 14 cases, postoperative adjuvant chemotherapy in 35 cases. The effective follow-up of 53 cases, 1,3 and 5-year survival rates were 83.1%, 54.7% and 28.3%. Fifty-one cases of bladder urothelial carcinoma were diagnosed by pathology after operation, of which 12 cases underwent total cystectomy, 3 partial resection of the bladder and 36 cases of TUBRT. After successful operation, 43 cases were followed up, and the 1,3 and 5 year survival rates were 81.8%, 76.7% and 72.7% respectively. Conclusions Bladder non-urothelial carcinoma is rare, with high malignancy and poor prognosis. Radical total cystectomy is the preferred surgical approach, combined with different types of tumor pathological features, auxiliary or neoadjuvant radiotherapy and chemotherapy is expected to improve the curative effect.