初发T1G3膀胱尿路上皮癌行膀胱全切还是保留膀胱手术？  

Management of primary T1G3 bladder cancer： immediate cystectomy or bladder preserving approach？

作　　者：孙晓文[1] 杨明山[2] 毕东滨[3] 李维国[1] 刘海涛[1] 韩邦曼 郭三维[1] 夏术阶[1] 

机构地区：[1]上海交通大学附属第一人民医院泌尿外科,200080 [2]山东省肿瘤医院泌尿外科 [3]山东省立医院泌尿外科

出　　处：《中华泌尿外科杂志》2008年第12期811-814,共4页Chinese Journal of Urology

摘　　要：目的比较根治性膀胱全切与保留膀胱手术治疗初发T1G3膀胱尿路上皮癌的临床效果。方法初发T1G3膀胱尿路上皮癌患者113例。男91例，女22例。年龄27～88岁，平均64岁。初次治疗保留膀胱患者81例，行根治性膀胱全切患者32例。采用Kaplan-Meier生存分析及log-rank检验比较2组患者5年总生存率及肿瘤特异性生存率。结果初次治疗保留膀胱患者81例中行经尿道肿瘤电切术74例、膀胱部分切除7例，术后随访6～140个月，平均64个月，术后5年总生存率为64．2％（52／81），肿瘤特异性生存率为77．8％（63／81）。根治性膀胱全切治疗32例，术后随访4～141个月，平均62个月，术后5年总生存率为59．4％（19／32），肿瘤特异性生存率为75．0％（24／32）。2组术后5年总生存率及肿瘤特异性生存率比较差异均无统计学意义（P〉0．05）。结论保留膀胱手术或根治性膀胱全切治疗初发T1G3膀胱癌，5年总生存率和肿瘤特异性生存率差异无统计学意义。膀胱全切治疗初发T1G3膀胱肿瘤至少有50％的病例有过度治疗的可能。Objective To compare the long-term outcomes in patients with newly diagnosed stage T1G3 bladder cancer treated with bladder preserving approach and intravesical instillation or immediate cystectomy. Methods Of 113 patients with a median age of 64 years （range 27 to 88） diagnosed with T1G3 bladder cancer from January 1993 to February 2007, 81 cases were treated by tran- sureteral resection with additional intravesical instillation and 32 were treated with immediate cystectomy. Differences between the 2 groups in 5-year overall survival and tumor specific survival were calculated using the Kaplan-Meier survival function and analyzed by the log rank test. Results Of 81 pa tients treated with organ preserving approach and postoperative intravesical instillation, 53 patients developed local recurrence and 21 patients underwent deferred cystectomy in a median 64 （range 6-- 140） months follow-up. The overall and tumor specific survival at 5 years was 64.2% （52/81） and 77.8Yoo（63/81）, and in those who had deferred cystectomy it was 61. 9% （13/21） and 76. 2%（16/ 21）, respectively. Of the 32 patients treated with immediate cystectomy, the 5 year overall and tumor specific survival was 59.4%（19/32） and 75.0% （24/32） within a median follow-up of 62（range 4-141）months. There was no statistical difference of the 5-year overall and tumor specific survival between patients treated with bladder preserving approach or immediate cystectomy. Conclusion Blad- der preserving approach and immediate cystectomy might have similar 5-year overall and tumor specific survival for primary T1G3 bladder cancers.

关 键 词：膀胱肿瘤 癌 外科手术 选择性 

分 类 号：R686[医药卫生—骨科学]