广东省医学会泌尿外科疑难病例多学科会诊(第18期)——女性尿道癌  

Multidisciplinary consultation on difficult cases in Guangdong Urological Association(Phase 18):female primary urethral carcinoma

作　　者：朱洪浩 范新祥[1] Zhu Honghao;Fan Xinxiang(Department of Urology,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou 510000,China)

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科,广州510000

出　　处：《中华腔镜泌尿外科杂志(电子版)》2025年第1期120-124,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金(82002682,82473159)。

摘　　要：本文报道一例因发现膀胱肿物继而确诊原发性尿道癌的女性病例。患者因“尿痛、尿频、尿急10天余”至中山大学孙逸仙纪念医院泌尿外科就诊。查CT提示膀胱肿物,行膀胱尿道镜检+诊断性经尿道电切术,见膀胱颈及尿道内口广基肿瘤,部分突入膀胱(尿道肿瘤);病理示高级别尿路上皮癌,浸润肌层。其后行全身PET/CT示尿道口周围残余部分病灶,脱氧葡萄糖代谢活跃,考虑恶性肿瘤可能。经科内病例讨论和与患方沟通后决定行新辅助治疗,方案为GC(吉西他滨+顺铂)联合PD1(替雷利珠单抗)。患者新辅助治疗后肿瘤明显缓解。拟行第四周期新辅助治疗前,患者出现发热,四级骨髓抑制。经广东省医学会泌尿外科疑难病例多学科会诊,专家建议与患方沟通行根治性膀胱切除+尿道全切除术,免疫治疗为可选择方案。经与患方沟通征得同意后,于我科行“双侧盆腔淋巴结清扫+膀胱-尿道全切除+子宫附件切除+阴道前壁部分切除+回肠通道术”。术后病理未见癌残留。对于局限性尿道癌的患者,术前GC联合PD1新辅助治疗疗效显著,值得推广。This article reports a case of a woman who was diagnosed with primary urethral cancer after the discovery of a bladder mass.The patient went to the Department of Urology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,for treatment due to"dysuria,frequent urination,and urgency for more than 10 days".CT examination showed bladder mass.Then cystourethroscopy combined with diagnostic transurethral resection was performed,and a broad-based tumor was found at the bladder neck and internal urethral orifice,which partially protruded into the bladder(urethral tumor),pathology showed high-grade urothelial carcinoma,infiltrating the muscle layer.Subsequently,whole-body PET/CT showed residual lesions around the urethral orifice,and flurodeoxyglacose metabolism was active,considering the possibility of malignant tumors.After discussion of the case within the department and communication with the patient,it was decided to perform neoadjuvant therapy:GC(Gemcitabine and Cisplatin)combined with PD1(Tislelizumab).Before the fourth cycle of neoadjuvant therapy,fever and grade 4 bone marrow suppression occurred.After a multidisciplinary consultation on difficult cases in the Guangdong Urological Association,experts recommended communicating with the patient to perform radical cystectomy and total urethrectomy,and immunotherapy was an optional option.After communicating with the patient and obtaining his consent,our department performed"bilateral pelvic lymph node dissection and complete bladder-urethra resection and uterine adnexectomy and partial vaginal anterior wall resection and ileal conduit".Postoperative pathology showed no cancer residue.For patients with localized urethral cancer,preoperative"GC combined with PDI"neoadjuvant therapy has significant efficacy and is worth promoting.

关 键 词：原发性尿道癌 女性 根治性膀胱切除 回肠通道 骨髓抑制 靶向治疗 免疫治疗 PD-I HER2 

分 类 号：R73[医药卫生—肿瘤]