膀胱部分切除术与根治性全膀胱切除术治疗局限性肌层浸润性膀胱癌的临床分析  

Comparison of therapeutic effects of partial cystectomy versus radical cystectomy for localized muscle invasive bladder cancer

作　　者：余昆[1] 代林 刘胜[1] 余志海[1] 李风[1] 刘美平[1] 石国忠[1] 夏宗禹[1] 

机构地区：[1]重庆三峡中心医院泌尿外科,重庆404000 [2]重庆市奉节县中医院外科,重庆404600

出　　处：《第三军医大学学报》2018年第2期169-175,共7页Journal of Third Military Medical University

摘　　要：目的比较膀胱部分切除术(partial cystectomy,PC)与根治性全膀胱切除术(radical cystectomy,RC)治疗局限性肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)的疗效。方法回顾性分析2007年12月至2012年3月本院收治的83例肌层浸润性膀胱癌患者,根据治疗方案的不同分为PC组与RC组。PC组患者采用PC+术后给予吉西他滨联合顺铂(GC)的全身化疗和膀胱灌注羟基喜树碱治疗;RC组患者接受RC+盆腔淋巴结清扫。对出院后患者进行随访,记录围手术期并发症发生情况、术后化疗不良反应并进行统计分析。采用Kaplan-Meier法比较两种术式患者5年总生存率(OS)、5年癌特异性生存率(CSS)的差异。结果经过4~60个月的随访(中位随访时间34个月),PC组围手术期并发症总发生率为6.38%,RC组为22.2%,两组患者并发症发生率差异有统计学意义(χ2=4.449,P=0.035)。PC组术后5年随访期内出现17例局部复发,复发率为36.2%;RC组随访期间局部复发9例,复发率为25.0%。两组患者复发率差异无统计学意义(χ2=1.182,P=0.277)。PC组随访期间死亡18例,死亡率为38.3%,其中13例死于膀胱癌全身转移。RC组死亡15例,死亡率为41.7%,其中9例死于膀胱癌复发并全身转移。采用Kaplan-Meier曲线对两组患者生存状况进行分析,PC组与RC组患者5年总生存率、5年癌特异性生存率分别为61.7%与58.3%、72.3%与75.0%,差异均无统计学意义(P>0.05)。结论 PC配合辅助化疗治疗局限性MIBC具有与RC相似的效果,是一种疗效确切、并发症发生率低、手术安全性高且操作相对简单的保留膀胱的手术。ObjectiveTo compare the therapeutic effects of partial cystectomy （PC） combined with chemotherapy vs radical cystectomy （RC） for treatment of localized muscleinvasive bladder cancer （MIBC）. MethodsA retrospective analysis was conducted among patients receiving surgeries for localized MIBC in our hospital between December, 2007 and March, 2012. According to the treatment plans, the patients were divided into PC group （47 patients） and RC group （36 patients）. In PC group, the patients received PC combined with postoperative systemic chemotherapy （gemcitabine combined with cisplatin） and bladder perfusion chemotherapy with hydroxycamptothecin, and those in RC group received RP with pelvic lymph node dissection. The patients were followed up for perioperative complications and adverse effects of postoperative chemotherapy, and their 5year overall survival （OS） and 5year cancerspecific survival （CSS） were analyzed by KaplanMeier analysis. ResultsDuring the followup for 4 to 60 months （median 34 months）, perioperative complications occurred in 6.38% of the patients in PC group, a rate significantly lower than that of 22.2% in RC group （Chisquore=4.449, P=0.035）. Postoperative recurrence occurred in 17 （36.2%） patients in PC group during the 5year follow up, as compared with 9 （25.0%） in RC group （Chisquore=1.182, P=0.277）. During the followup, death occurred in 18 （38.3%） cases in PC group, including 13 cases due to bladder cancer metastasis; death occurred in 15 （41.7%） cases in RC group, including 9 cases due to cancer metastasis. The 5year OS and CSS were 61.7% and 72.3% in PC group and were 58.3% and 75.0% in RC group, respectively, showing no significant differences between the 2 groups （P〉0.05）. ConclusionPartial resection of the bladder with adjuvant chemotherapy has a similar effect to radical cystectomy for treatment of localized MIBC, but partial resection is associated with a lower incidence of complications,

关 键 词：膀胱部分切除术 根治性全膀胱切除术 肌层浸润性膀胱癌 化疗 

分 类 号：R615[医药卫生—外科学] R699.5[医药卫生—临床医学]