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目的:探讨膀胱非尿路上皮性肿瘤的诊断、治疗方法和预后。方法:回顾性分析2002年1月～2010年12月收治的46例膀胱非尿路上皮性肿瘤患者的临床资料:男34例,女12例。年龄30～82岁,平均61.3岁。术前辅助检查主要包括B超、盆腔CT、膀胱镜加病理活检以及131I-MIBG。42例行手术治疗,4例放弃手术。结果:46例术前或术后病理检查诊断为膀胱鳞状细胞癌19例,膀胱腺癌18例(单纯性非脐尿管腺癌8例,脐尿管腺癌5例,转移性腺癌5例),膀胱小细胞癌4例,膀胱嗜铬细胞瘤5例。术后40例随访12～72个月,膀胱嗜铬细胞瘤5例均健在,膀胱鳞癌及腺癌各2例随访至14～26个月仍存活,其余患者平均存活时间13.2个月。结论:膀胱非尿路上皮恶性肿瘤恶性程度高,确诊时大多已是晚期,预后差。膀胱根治性切除术是除转移性癌和小细胞癌外的膀胱非尿路上皮性恶性肿瘤的推荐手术方案,小细胞癌以化疗为主,转移性癌以改善尿路症状为主,良性嗜铬细胞瘤以膀胱部分切除为主。
Objective: To investigate the diagnosis, treatment and prognosis of bladder non-urothelial tumors. Methods: The clinical data of 46 patients with bladder non-urothelial carcinoma admitted in our hospital from January 2002 to December 2010 were retrospectively analyzed. There were 34 males and 12 females. Age 30 ~ 82 years old, average 61.3 years old. Preoperative auxiliary examinations include B-, pelvic CT, cystoscopy plus biopsy and 131I-MIBG. 42 patients underwent surgical treatment and 4 patients gave up surgery. Results: 46 cases were diagnosed as bladder squamous cell carcinoma in 19 cases and 18 cases of bladder adenocarcinoma (8 cases of simple non-ureteral adenocarcinoma, 5 cases of urachal adenocarcinoma, 5 cases of metastatic adenocarcinoma Cases), small cell carcinoma of the bladder in 4 cases, bladder pheochromocytoma in 5 cases. Forty cases were followed up for 12 to 72 months. Five cases of bladder pheochromocytoma were alive. Two cases of bladder squamous cell carcinoma and two cases of adenocarcinoma survived after 14 to 26 months of follow-up. The average survival time of other patients was 13.2 months. Conclusions: Bladder non-urothelial carcinomas are highly malignant, most of which are late diagnosed with poor prognosis. Bladder radical resection in addition to metastatic and small cell carcinoma of the bladder outside the urinary tract epithelial malignancy recommended surgical options, small cell carcinoma with chemotherapy-based, metastatic cancer to improve the main urinary tract symptoms, benign Chromocytoma partially excised bladder.