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目的:探讨膀胱尿路上皮癌行根治性膀胱切除原位回肠新膀胱术后尿道复发的原因及治疗方法。方法:回顾403例膀胱尿路上皮癌行根治性膀胱切除原位回肠新膀胱术的患者资料,总结尿道肿瘤的复发率、原因、诊断、治疗和预后。结果:6例患者出现尿道肿瘤复发,复发率为1.5%,均为男性。2例浸润性尿道肿瘤和1例尿道广泛表浅性乳头状瘤行全尿道切除术和新膀胱造瘘术,3例尿道表浅性乳头状瘤行经尿道肿瘤切除术和尿道内灌注化疗,术后2例复发,再次行全尿道切除术。2例浸润性尿道肿瘤和1例尿道广泛表浅性乳头状瘤在2年内因肿瘤复发或转移死亡。结论:膀胱多发原位癌、肿瘤侵犯前列腺尿道和基质、女性膀胱颈部是尿道复发主要原因。原位新膀胱的尿道复发率低于其他尿流改道术,全尿道切除术是尿道复发更可靠的治疗方案,尿道表浅性肿瘤的预后明显好于浸润性肿瘤。
Objective: To investigate the causes and treatment of urethral recurrence of bladder urothelial carcinoma after radical cystectomy in situ ileal neo-bladder surgery. Methods: The data of 403 patients with bladder urothelial carcinoma who underwent radical cystectomy and ileal neo-bladder surgery were retrospectively reviewed. The recurrence rate, cause, diagnosis, treatment and prognosis of urethral tumor were summarized. Results: Six patients developed urethral tumor recurrence rate of 1.5%, both were male. 2 cases of invasive urethral tumor and 1 case of extensive superficial papilloma of the urethra underwent total urethroplasty and neo-bladder ostomy, 3 cases of urethral superficial papilloma underwent transurethral resection and intra-urethral chemotherapy After 2 cases of recurrence, again underwent total urethroplasty. Two cases of invasive urethral tumor and one case of extensive urethral papilloma died of tumor recurrence or metastasis within 2 years. Conclusions: Multiple bladder carcinoma in situ, tumor invasion of prostate urethra and stroma and female bladder neck are the main causes of urethral recurrence. Urinary tract in situ urinary tract recurrence rate is lower than other urinary diversions, total urethral resection is a more reliable treatment of urethral recurrence, the prognosis of superficial urethral tumors was significantly better than invasive tumors.