膀胱癌根治术患者前列腺偶发癌的临床病理特点及其对预后的影响  

Pathology features of incidentally discovered prostatic cancer from radical cystectomy and its effectson the patients prognosis

作　　者：胡小鹏[1] 薛文瑞[1] 王伟[1] 王勇[1] 张小东[1] 

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,100020

出　　处：《中华泌尿外科杂志》2016年第5期340-343,共4页Chinese Journal of Urology

基　　金：北京市自然科学基金（7132107）;北京市卫生系统高层次卫生技术人才基金（2013-3-015）

摘　　要：目的探讨行根治性膀胱前列腺切除术（radicalcystopmstatectomy，RCP）治疗的肌层浸润性膀胱癌患者前列腺偶发癌的发生率、病理特点及其对预后的影响。评估行保留神经血管束（neurovascularbundle，NVB）手术患者的术后勃起功能。方法回顾性分析2002年1月至2015年1月收治的150例男性肌层浸润性膀胱癌患者的资料，年龄41～83岁，平均63岁。术前总前列腺特异性抗原（tPSA）为0．2～7．8ns／ml，平均3．0ng／ml。直肠指检均为阴性。CT增强扫描显示仅1例膀胱癌侵犯前列腺，余前列腺大小、形态及实质内未见明显异常征象。150例均行RCP，其中133例为开放手术，17例为腹腔镜手术。13例行保留NVB术式，其中11例为开放手术，2例为腹腔镜手术。结果本组150例中，11例（7．3％）术后病理诊断为前列腺偶发癌，病理类型均为前列腺腺癌。11例患者的年龄42—82岁，平均66岁；术前tPSA0．3—4．0ng／ml，平均2．6ng／ml。患有前列腺偶发癌组和未患组的术前tPSA平均值（2．6vs．3．2ng／m1）比较差异无统计学意义（P〉0．05）。11例术前cT增强扫描检查示前列腺未见异常10例，膀胱癌侵犯前列腺1例。11例中9例前列腺偶发癌为低危等级（Gleason评分≤6分，临床分期≤T：期）。11例中，10例膀胱癌组织学类型为尿路上皮癌，1例为小细胞癌；膀胱癌TNM分期≤pT2期4例，≥pT3期7例。Gleason评分〈6分5例，6分5例，10分1例。肿瘤切缘阳性2例。11例均未接受去势治疗，随访6～24个月，平均10个月，无死亡病例，复查tPSA值均≤0．003ng／ml。13例行保留NVB术式的患者中8例术后勃起功能恢复良好。结论肌层浸润性膀胱癌患者前列腺偶发癌发病率较低，大多数前列腺偶发癌为低危等级，是否伴前列腺偶发癌对患者预后无影响。行保留NVB手术有助于患者术后勃起功能的恢复。Objective To assess the incidence, clinic feature, pathological characteristics and prognosis of incidental prostate cancer from specimens via radical cystoprostatectomy （RCP） for muscleinvasive bladder cancer. The postoperative erectile function in patients with NVB operation are also to be evaluated. Methods Between Jan 2002 and Jan 2015, 150 male patients with bladder cancer who underwent radical cystoprostatectomy in our center were included in this study. 133 patients underwent open surgery and 17 eases underwent laparoscopic operation （13 patients underwent NVB operation）. The average age of 150 patients was 63 years （ranging 41 to 83 years）. The average tPSA was 3 ng/ml（ranging 0.2 to 7. 8 ng/ml）. The digital rectal examination was negative, CT results didnt exhibit the evident of abnormality in prostate. Results Overall, incidental prostate cancer was diagnosed in 11 male patients （7. 3% ）. The pathological diagnosis are all prostatic adenocarcinoma. In those patients, the mean age was 65.5 years （ranging 42 to 82 years）. The mean tPSA at the time of surgery was 2. 6 ng/ml （0. 3-4. 0 ng/ml）. There was no statistical significance of tPSA values in the incidental prostate cancer group and non risk group （2. 6 vs. 3.2ng/ml） （P 〉 0. 05）. The preoperative enhanced CT imaging showed normal prostate in 7 cases ,prostate hyperplasia in 2 cases , prostate calcification in 1 cases and bladder cancer invasion into the prostate in 1 cases. 9 cases of incidental prostate cancer are low risk grade （ Gleason score ≤ 6, the clinical stage T2 ）. Among 11 cases, bladder cancer histologic type in 10 cases was transitional cell carcinoma and small cell carcinoma in 1 case. According to the TNM classification, 4 cases were less than pT2 stage and 7 cases were more than pT3 stage. 11 patients were followed up between 6 to 24 months （mean 10 months）. All patient survived at the end of study without the treatment of castration. Among 13 cases accepted NVB operation, 8 cases achieve

关 键 词：膀胱前列腺切除术 前列腺偶发癌 前列腺特异性抗原 膀胱癌 

分 类 号：R737.25[医药卫生—肿瘤]