高级别T1期膀胱尿路上皮癌保留膀胱术后转归分析

潘东亮 李宁忱 晋连超 张祥华 那彦群

北京大学首钢医院泌尿外科，北京100144

〔摘要〕背景与目的 对于经膀胱内治疗失败的高级别T1膀胱尿路上皮癌应积极采取膀胱全切术，但是部分此类患者由于某种原因接受了膀胱保留术式，其转归历程如何?到目前为止，尚缺乏系统报道。本研究旨在分析高级别T1膀胱尿路上皮癌保留膀胱术后转归特点。

方法 介绍2005年1月～2006年2月首次在北京大学首钢医院行经尿道膀胱肿瘤切除或膀胱部分切除术的7例T1膀胱尿路上皮癌患者，术后膀胱肿瘤复发但未行膀胱全切术直至死亡的临床过程。7例均采用入院诊治的方法随访。

结果 7例T1膀胱癌均具有多发、高级别等高危因素，未行膀胱全切术原因分别是3例81、83、86岁高龄、4例严重心脏病，存活6～65个月(平均42.3个月)，发生严重血尿7例、骨转移6例、肺转移5例、肝转移5例、肾上腺转移3例、胸壁转移1例，均死于膀胱癌相关事件。

结论 高级别T1膀胱尿路上皮癌保留膀胱术后存活时间较短;易多处远处转移，以骨肺肝最常见;血尿严重，但无持续有效治疗方法。

〔关键词〕癌，尿路上皮;膀胱;高级别;T1期;保留膀胱

Analysis of the outcomes and progress of patients with high-grade T1

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通讯作者：那彦群 E-mail: nayanqun@cuan.com

stage urothelial carcinoma of bladder after bladder-sparing operation PAN Dong-liang, LI Ning-chen, JIN Lian-chao, ZHANG Xiang-hua, NA Yan-qun (WujiepingUrologyMedicalCenterof Peking University, Department of Urology,PekingUniversityShougangHospital,Beijing100144,China)

Correspondence to: NA Yan-qun E-mail: nayanqun@cuan.com

[Abstract] Background and purpose Patients with high-grade T1 urothelial carcinoma of bladder should undergo radical cystectomy whose intravesical treatments failed. Nevertheless, some patients finally accepted bladder-sparing operations because of some reasons. Until now, no systemic and intact report about the progress and outcomes of these patients occurred. So the aim of our research is to analyze the characteristics about the outcomes and progress of patients with high-grade T1 urothelial carcinoma of bladder after bladder-sparing operation. Methods Seven patients with high-grade T1 urothelial carcinoma of bladder underwent transurethral resection of tumor or partial cystectomy from January, 2005 to February, 2006. The whole process and data of their postoperative follow-up and treatment were recorded by means of in-patient until to the end of their lives. Outcomes The high-risk characteristics of these seven patients with T1 urothelial carcinoma of bladder was multi-focus and high-grade of cancer. They could not suffer radical cystectomy because of contraindications of severe cardiac disease for 4 patients and old age of 81～86 years for 3 patients. They all died of bladder carcinoma-correlative disease and their cancer specific survival time was 6～65 months( average 42.3 mon). Severe hematuria happened to 7 patients and -stasis to bone, lung, liver, adrenal and thoracic cavity wall did to 6, 5, 5, 3 and 1 patients, respectively. Conclusions The cancer specific survival time was short for patients with high-grade T1urothelial carcinoma of bladder after bladder-sparing operation. -stasis to multiple far-distance organs occurred frequently, such as bone, lung and liver. There was no persistently effective therapy for severe hematuria.

[Key words] Carcinoma, Urothelial; Bladder; High-grade; T1 stage; Bladder-sparing

对于经膀胱内治疗失败的高级别T1膀胱尿路上皮癌应积极采取膀胱全切术，可获得较好的预后[1]。但是部分此类患者由于个人意愿或手术耐受力等原因接受了膀胱保留术式，其转归历程如何?到目前为止，尚缺乏系统报道。本文分析2005年1月～2006年2月首次在北京大学首钢医院行经尿道膀胱肿瘤切除或膀胱部分切除术的7例T1膀胱尿路上皮癌患者，术后膀胱肿瘤复发但未行膀胱全切术直至死亡的临床过程。

1 资料和方法

1.1 研究对象 T1膀胱尿路上皮癌患者7例，男性6例，女性1例。年龄72～86岁，平均77.3±8.2岁。

1.2研究方法 查阅本组患者病历，记录首次住院时病史、体征、辅助检查、诊治经过及以后历次住院复查、治疗的主要信息。

2 结果

2.1 病史和体征 均因间断无痛性肉眼血尿先后于2005年1月～2006年2月首次就诊。伴尿频6例。3例患糖尿病史6～17年，4例患严重冠心病3～8年。体检无阳性体征。

2.2 实验室检查结果 均行血常规、血生化、尿常规、尿肿瘤细胞学检查。6例血常规结果正常，1例红细胞3.49×1012/L，血红蛋白113g/L。4例尿常规中红细胞满视野，3例尿常规中红细胞4+，均无白细胞。7例血生化结果均正常。5例尿肿瘤细胞学检查发现尿路上皮癌细胞，2例阴性。

2.3 影像学检查结果

2.3.1 B超检查 7例均行泌尿系B超检查，发现双侧肾脏形态大小正常，集合系统无扩张和充盈缺损;输尿管无异常;膀胱充盈良好，膀胱左或右或顶或后壁结节2～3枚，结节最大径均