膀胱全切除输尿管皮肤造瘘治疗高龄T_3期膀胱肿瘤的体会(附47例报告)  

Experience on treating the elder patients with cT_3 bladder tumor by cystectomy and ureterocutaneostomy(Report of 47 cases)

作　　者：张心如[1] 乔勇[1] 谷宝军[1] 金三宝[1] 陈嵘[1] 金重睿[1] 司捷旻[1] 

机构地区：[1]上海交通大学附属第六人民医院泌尿外科,上海200233

出　　处：《临床泌尿外科杂志》2012年第10期759-763,766,共6页Journal of Clinical Urology

摘　　要：目的:总结高龄T3期膀胱肿瘤行全膀胱切除并输尿管皮肤造瘘的经验。方法:2004～2011年,47例超过75岁T3期膀胱肿瘤患者接受全膀胱切除并输尿管皮肤造瘘,9例为初发,38例为复发肿瘤,既往平均手术次数(2.7±1.7)次。25例(53.2%)合并有其他器官的慢性疾病。所有患者于术中同时行双侧盆腔淋巴清扫,1例因尿道腔内肿瘤生长行尿道全切除并阴道前壁部分切除。术后输尿管内留置F7单J支架管并定期更换。以QLQ-C30(v3.0)中文版量表评价患者术前,术后6个月,12个月的生活质量。结果:47例均顺利完成手术,无术中或围手术期死亡病例。手术平均时间(266±33)min,围手术期平均输血(728±309)ml。术后病理分级T2b2例,T3a26例,T3b15例,T4a4例,N214例,N31例。随访11～67个月,平均(32.4±15.1)个月。23例(48.9%)术后3～36个月出现肿瘤复发及转移。24例(40.4%)随访中死亡,17例死于肿瘤转移,7例死于非肿瘤相关原因。23例生存至今,19例(40.4%)无瘤生存15～67个月,平均(41.5±16.2)个月,4例(8.5%)带瘤生存19～30个月。17例(36.2%)出现并发症:7例单侧肾功能下降,1例双侧肾功能减退。11例经历至少1次肾盂肾炎(2例合并单侧肾功能减退)。32例完成术后6个月QLQ-C30测定,22例完成术后12个月测定,经统计检验,术后6个月患者情绪功能改变以及术后6个月,12个月患者的主观健康状况及生活质量均与术前存在显著统计学差异。结论:高龄T3期膀胱肿瘤患者可耐受全膀胱切除,应于术中尽量缩短手术时间,缩小手术区域,以提高患者手术耐受能力。对于高龄患者,输尿管皮肤造瘘并于输尿管内长期留置输尿管支架是全膀胱切除后简便,安全,并发症少且处理简单的尿流改道方式。全膀胱切除术对提高高龄T3膀胱肿瘤患者术后生活质量和主观健康状况有积极意义。Objective：To study our experience on treating the elder patients with cT3 bladder tumor by cystectomy and ureterocutaneostomy. Method：From 2004.1 to 2011.12,47 patients over 75 years old with cT3 bladder tumor underwent cystectomy and ureterocutaneostomy in our hospital. 9 cases were primary tumor and the rest were recurrence tumor. An average（2.7±1.7）pervious procedures were underwent before surgery. 25 cases （53.2%）had no urinary system related comorbidities. All the patients accepted bilateral pelvic lymphadenectomy at the same time when cystectomy was performed. Urethra was reseeted in i case due to cancer infiltration. F7 ureteral single J stents were indwelled in each ureter and replaced regularly every two months. EORTC QLQ-C30 （v3.0）Chinese version was used in preoperation,6tb and 12th months postoperative to assess the quality of life of patients. Result：No death was reported during peroperative period. Mean operation time was（266±33）minutes and mean blood transfusion during preoperative period was（728±309）ml. Postoperative pathologic examination staged Tzu in 2 cases,Ta, in 26 cases,Tab in 15 cases,T4, in 4 cases,while N2 in 14 cases,and Na in 1 case. Within the average（32.4± 15.1） months follow up（ 11 -- 67 months）, 23 cases（48.9 % ） were detected tumor recurrence or metastasis within 3 to 36 months postoperatively. Among 24 cases who died（40.4 % ）during the follow up, 17 cases died with tumor metastasis and 7 cases died with no tumor related reasons. Among 23 survival patients, 19 patients （40.4%）accomplished no tumor survival from 15 to 67 month,mean（41.5±16.2）months. 4 patients（8.5%）survived with tumor from 19 to 30 months. 17 patients（36.2%）were reported complications occurred. Unilateral renal function deterioration was detected in 7 patients and bilateral renal function deterioration was detected in 1 patient. 11 patients experienced at least once pyelonephritis during the follow up（2 of them combined with unilateral renal function

关 键 词：膀胱肿瘤 肌层浸润性 高龄 全膀胱切除 输尿管皮肤造瘘 生活质量 QLQ-C30(v3.0)中文版 

分 类 号：R737.14[医药卫生—肿瘤]