膀胱小细胞癌18例诊治分析  

Small cell carcinoma of the bladder： dagnosis and treatment of 18 cases

作　　者：石都 孔垂泽[1] 李振华[1] 赵伟[1] 满晓军[1] 

机构地区：[1]中国医科大学附属第一医院泌尿外科,110001

出　　处：《中华泌尿外科杂志》2016年第8期607-610,共4页Chinese Journal of Urology

摘　　要：目的 探讨膀胱小细胞癌的临床特点及诊治方法.方法 回顾性分析2009年3月至2015年10月收治的18例膀胱小细胞癌患者的临床资料.男16例,女2例;年龄54 ～ 81岁,平均61岁.临床表现为肉眼血尿11例,尿急2例,排尿困难2例,膀胱尿路上皮癌行TURBT后复查3例.肿瘤直径1.0～6.0 cm,平均3.4 cm.2例行TURBT,术后行膀胱灌注化疗;3例行膀胱部分切除术,1例术后行静脉化疗联合盆腔放疗,2例拒绝后续治疗;13例行根治性膀胱切除术,2例术后行静脉化疗,2例行盆腔放疗,2例行静脉化疗联合放疗,余7例患者拒绝后续治疗.结果 18例病理诊断为单纯型膀胱小细胞癌11例,混合型膀胱小细胞癌7例,均合并膀胱尿路上皮癌.TNM肿瘤分期：T1N0M0期3例,T2N0～1 M0期4例,T3N0～2M0期11例.随访5～ 35个月,9例死于肿瘤转移,9例存活至今,其中1例出现盆腔淋巴结转移,余未发现肿瘤复发或转移.结论 膀胱小细胞癌临床罕见,恶性程度高,预后差,单纯型较混合型膀胱小细胞癌预后可能更差.诊断主要靠病理学检查.根治性膀胱切除为主要治疗方法,保留膀胱治疗策略对于适当患者可以尝试.联合辅助治疗效果可能更佳.Objective To study the clinical features,diagnosis and management of small cell carcinoma of the bladder （SCCB）.Method The clinical data of 18 cases of patients with small cell carcinoma of the bladder were analyzed retrospectively and the literature were reviewed.There were 16 males and 2 females,ages 54 to 81 years （median age,61 years）.Clinical manifestations included gross hematuria in 11 cases,urgency in 2 cases,dysuria in 2 cases and postoperative review after TURBT of bladder urothelial carcinoma in 3 cases.The median tumor size was 3.35cm （ranged,1.0 to 6.0 cm）.2 cases underwent TURBT and intravesical chemotherapy regularly were followed after surgery.3 cases underwent partial cystectomy,intravenous chemotherapy combined with radiotherapy was followed in one case,the other 2 cases refused the following therapy.13 cases underwent radical cystectomy,intravenous chemotherapy was followed in 2 cases,pelvic radiotherapy was followed in 2 csaes and intravenous chemotherapy combined with radiotherapy was followed in 2 cases,the other 7 cases refused the following therapy.Results 11 cases were pure SCCB,7 cases were mixed SCCB,all with urothelial carcinoma.T1N0M0 in 3 cases,T2N0.1M0 in 4 cases,and T3N0-2M0 in 11 cases.The duration of follow-up was from 5 to 35 months after surgery.9 cases died of tumor metastasis,9 cases are still alive,except 1 case with lymph node metastasis,the other 7 cases are free of tumor recurrence or metastasis.Conclusions SCCB is rare,with high malignant degree and poor prognosis.The prognosis of the pure SCCB may be worse than the mixed SCCB.The diagnosis depends on pathology examination.Radical cystectomy is the main treatment method,the strategy of bladder-preserving may be an attempt for proper SCCB patients.Adjuvant therapy plus surgery may be better.

关 键 词：膀胱肿瘤 小细胞癌 诊断 治疗 

分 类 号：R737.14[医药卫生—肿瘤]