保留女性生殖器官膀胱切除术的临床预后分析(附87例报告)  

Clinical prognosis of pelvic organ-preserving radical cystectomy in women:report of 87 cases

作　　者：唐世英 郝瀚[1] 方冬[1] 郑卫[1] 彭东 詹永豪 鲍正清 李学松[1] 周利群[1] 

机构地区：[1]北京大学第一医院泌尿外科北京大学泌尿外科研究所国家泌尿男性生殖系肿瘤研究中心,北京100034

出　　处：《临床泌尿外科杂志》2017年第10期741-745,750,共6页Journal of Clinical Urology

摘　　要：目的:分析保留女性生殖器官的膀胱切除术的临床预后情况,探讨保留女性生殖器官的根治性膀胱切除术的临床应用。方法:回顾性分析2006年1月~2012年12月我院行膀胱切除术的87例女性患者的临床资料。根据手术方式是否保留女性生殖器官分为保留女性生殖器官组(52例)和传统组(35例)。两组年龄、既往疾病史、BMI指数差异均无统计学意义(P>0.05)。比较两组手术情况、术后病理学特征、术后恢复情况及两组预后情况。结果:两组尿路改道方式、手术入路、术后并发症、术中出血情况、平均住院日和术后病理分期分级差异均无统计学意义(P>0.05)。传统组平均手术时间明显长于保留女性生殖器官组[(371.71±108.72)min vs.(294.42±93.67)min,P=0.001];保留女性生殖器官组术后恢复进食时间与传统组比较差异有统计学意义[(4.29±1.81)d vs.(5.77±3.83)d,P=0.019)]。两组在肿瘤无进展生存率、肿瘤特异性生存率及总生存率方面差异均无统计学意义(P>0.05)。亚组分析中,在高危膀胱癌患者(≥T_3N_0M_0和/或G_3)中,两组在预后方面差异仍无统计学意义。结论:保留女性生殖器官的膀胱切除术在预后方面可以与传统的根治性膀胱切除术相媲美,即使是在高肿瘤分期和(或)肿瘤分级中。这种保留女性生殖器官的手术技术能极大的保留女性生殖功能,更好的提升患者术后的生活质量。因此,对于一些经过特定选择的女性膀胱癌患者,应尽可能行保留女性生殖功能的膀胱全切术,当然要注意该手术适应证的选择。Objective：To assess clinical prognosis and explore the clinical application of pelvic organ-preserving radical cystectomy（RC）in women.Method：A retrospective review of 87 women patients with bladder cancer followed radical cystectomy was performed from January 2006 to December 2012.The patients were divided into two groups：pelvic organ-preserving group（52 patients）and traditional group（35 patients）,in terms of surgical method.There was no significant difference in age,previous medical illness and body mass index（BMI）（P〉0.05）.The surgical operation,pathological features,postoperative recovery and prognosis were analyzed and compared between two groups.Result：Urinary diversion,surgical approach,complication,blood loss,postoperative hospital stay and tumor stage showed no significant difference between two groups（P〉0.05）.The surgical time in traditional group was longer than that in pelvic organ-preserving group obviously[（371.71±108.72）min vs.（294.42±93.67）min,P=0.001];the time of postoperative food intake in pelvic organ-preserving group was earlier than that of traditional group[（4.29±1.81）d vs.（5.77±3.83）d,P=0.0190].In Kaplan-Meier analysis,these two groups showed no significant difference in tumor progression-free survival（PFS）,cancer-specific survival（CSS）and overall survival（OS）,even in some selected high risk patients in bladder cancer（tumor stage≥T3N0M0 or tumor grade G3）.Conclusion：Pelvic organ-preserving radical cystectomy could be comparable to traditional radical cystectomy in terms of prognosis,even in high tumor staging or tumor grade.This technique of preserving female genital organs can greatly preserve female reproductive function and improve the quality of life of patients after operation.Therefore,some specific selected female bladder cancer patients who were conformed with surgical indications could be performed pelvic organ-preserving radical cystectomy as far as possible.

关 键 词：膀胱癌 保留女性生殖器官 膀胱切除术 预后 

分 类 号：R737.14[医药卫生—肿瘤]