根治性膀胱切除术后发生尿道癌的危险因素分析  

Risk factors of urethral recurrences following radical cystectomy for bladder cancer

作　　者：张东正[1] 高靖达 王鑫朋 张瑞珊[1] 王锐[1] 刘春雨[1] 刘利维[1] 

机构地区：[1]天津医科大学第二医院泌尿外科 天津市泌尿外科研究所 天津市泌尿外科基础医学重点实验室,300211

出　　处：《中华泌尿外科杂志》2016年第9期681-684,共4页Chinese Journal of Urology

摘　　要：目的：探讨根治性膀胱切除术后发生尿道癌的危险因素。方法回顾性分析2005年1月至2013年1月收治的350例行根治性膀胱切除术患者的临床资料。患者均为男性。年龄46～76岁，平均63岁。176例既往有非肌层浸润性膀胱癌（ non-muscle-invasive bladder cancer，NMIBC）病史。15例肿瘤侵及前列腺部尿道。根治性膀胱切除术中尿流改道方式为：原位新膀胱172例，输尿管皮肤造瘘90例，回肠膀胱88例。331例术前行膀胱灌注化疗，36例术后行全身化疗。148例肿瘤病灶≥2处，189例肿瘤分期≥T2期，177例为高级别尿路上皮癌。采用多因素Cox回归分析根治性膀胱切除术后发生尿道癌的危险因素。结果本组350例，28例（8.0％）术后发生尿道癌。多因素Cox回归分析结果显示既往NMIBC病史（HR＝15.205，95％CI 3.718～62.180，P＜0.001）、肿瘤侵及前列腺部尿道（HR＝5.233，95％CI 1.106～24.754，P＝0.037）、非原位新膀胱术（输尿管皮肤造瘘术和回肠通道术）（HR＝6.656，95％CI 1.840～24.077，P＝0.004）是根治性膀胱切除术后发生尿道癌的独立危险因素。术前膀胱灌注化疗（HR＝0.470，95％CI 0.010～0.217，P＜0.001）是发生尿道癌的保护因素。结论既往NMIBC病史、肿瘤侵及前列腺、非原位新膀胱术是根治性膀胱切除术后发生尿道癌的独立危险因素，术前灌注化疗是术后发生尿道癌的保护因素。术前常规行膀胱灌注治疗和对具备危险因素患者行尿道切除术有重要意义。Objective To evaluated the risk factors of urethral recurrence （ UR） following radical cystectomy （ RC） in patients with bladder urothelial carcinoma.Methods The clinical data of 350 male patients who underwent RC between January 2005 and January 2013 were retrospectively analyzed.The mean age was 63 years （rang 46-76） years.176 cases had the history of non-muscle-invasive bladder cancer.15 cases were were found the tumor invasion into the prostatic urethral.The way of urinary diversion after RC included 172 cases were orthotopic neobladder, 90 cases were cutaneous diversion and 88 cases were ileal couduitin.331 cases underwent preoperation intravesical instillation.36 cases underwent systemic chemotherapy after operation.148 cases were found the multiple tumor lesions, which was more than 2 sites. The pathological stage was more than T2 satge in 189 cases.And 177 cases were diagnosed as high-grade urothelial carcinoma.Multivariate Cox regression analyses were used to evaluate the risk factors associated with the UR.Results There were 350 cases in this study, UR was observed in 28 cases （ 8%）.On multivariate Cox regression analyses, previous history of NMIBC （HR=15.205,95%CI 3.718-62.180,P〈0.001）, prostate urethral involvement（HR=5.233,95%CI 1.106-24.754,P=0.037） and Non-orthotopic neobladder（HR=6.656,95%CI 1.840-24.077,P=0.004）which the operation of cutaneous diversion and ileal couduit , were independent risk factors of UR following RC.Intravesical instillation before operation （ HR =0.470, 95%CI 0.010-0.217, P 〈0.001 ） was the protective factor of the UR.Conclusions Previous history of NMIBC, prostatic urethral involvement and Non-orthotopic neobladder were independent risk factors of UR.Intravesical instillation before operation was protective factor of UR.Urethrectomy for patients with high risk factors and intravesical instillation before operation were important.

关 键 词：膀胱癌 尿道癌 根治性膀胱切除术 危险因素 

分 类 号：R737.14[医药卫生—肿瘤]