浸润性膀胱癌保留膀胱的综合治疗疗效分析

发布时间：2018-06-26 18:34

本文选题：肌层浸润性膀胱癌 + 根治性膀胱切除术　；参考：《青岛大学》2014年硕士论文

【摘要】：目的探讨保留膀胱手术结合放化疗在肌层浸润性膀胱癌(MIBC)治疗中的价值。方法收集我院2003年1月至2010年8月MIBC病例72例,根据治疗方式,其中保留膀胱组42例,根治性膀胱切除组30例。保留膀胱组采用膀胱部分切除(PC)或经尿道膀胱肿瘤切除(TURBT);28例采用膀胱部分切除,14例采用TURBT,所有保留膀胱的病人均完成化疗；其中5例因肿瘤未完全切除或切缘阳性放疗。通过住院病历、门诊及电话等方式随访,应用Kaplan-meier法和Log-rank检验,比较2组生存情况。结果 72例肌层浸润性膀胱癌,男54例,女18例,平均年龄67.3岁(40-85岁),随访病人56例,随访率78%。患者随访12-92个月,平均随访43.1个月,中位随访时间为50个月。保留膀胱组肿瘤局部复发共24例,其中非肌层侵润性复发16例,肌层侵润性复发8例。6例肌层侵润性复发再次行TURBT或膀胱部分切除,结合放化疗治疗。1例行挽救性膀胱癌根治术。1例因远处转移行姑息性TURBT。随访期间,死于膀胱癌者34例,保留膀胱组21例(50%),根治性膀胱切除组13例(43%)；死于非膀胱肿瘤者2例。保留膀胱组生存时间均数为50.721月,中位数为47月；根治性膀胱切除组生存时间为57.540月,中位数为52月。术后1、2、3、4、5年生存率保留膀胱组分别为88.1%、83.3%、61.9%、57.1%、47.6%,根治性膀胱切除组分别为86.7%、80.0%、66.7%、63.6%、53.3%。经Kaplan-Meier分析提示两组生存时间无统计学差异(P=0.7590.05)。结论 1、MIBC采取保留膀胱的综合治疗可达到与根治性膀胱切除相似的生存率。 2、对拒绝或身体条件差不能耐受膀胱根治性切除的MIBC患者,保留膀胱的综合治疗是一种合理的治疗方式。
[Abstract]:Objective to investigate the value of bladder preserving surgery combined with radiotherapy and chemotherapy in the treatment of myometrial invasive bladder cancer (MIBC). Methods from January 2003 to August 2010, 72 cases of MIBC in our hospital were collected. According to the treatment methods, 42 cases were in bladder preserving group and 30 cases in radical cystectomy group. Cystectomy (PC) or transurethral resection of bladder neoplasms (TURBT) were performed in 28 patients with cystectomy (PC) or transurethral resection of bladder tumor (TURBT). Kaplan-meier method and Log-rank test were used to compare the survival of the two groups. Results 72 cases (54 males and 18 females, mean age 67.3 years (40-85 years) were followed up in 72 cases (54 males and 18 females). 56 cases were followed up and the follow-up rate was 78g%. Patients were followed up for 12-92 months with an average of 43.1 months, with a median follow-up time of 50 months. There were 24 cases of local recurrence of tumor in bladder retention group, including 16 cases of non-muscular invasion recurrence, and 8 cases of muscular invasion recurrence. 6 cases of muscle invasion recurrence were treated with TURBT or partial cystectomy again. Combined with radiotherapy and chemotherapy, 1 cases of radical resection of salvage bladder cancer were treated with palliative TURBT due to distant metastasis. During the follow-up period, 34 cases died of bladder cancer, 21 cases (50%) died of bladder preservation, 13 cases (43%) died of radical cystectomy, and 2 cases died of non-bladder tumor. The mean survival time of bladder retention group was 50.721 months, the median was 47 months, and that of radical cystectomy group was 57.540 months, the median was 52 months. The 4 and 5 year survival rates in the bladder retention group were 88.1and 83.3, respectively, and 57.1% and 47.6%, respectively, in the radical cystectomy group, 86.7% and 63.6% in the radical cystectomy group, respectively, and 53.3% in the radical cystectomy group. Kaplan-Meier analysis showed that there was no significant difference in survival time between the two groups (P0. 7590.05). Conclusion (1) the survival rate of MIBC treated with bladder retention is similar to that of radical cystectomy. 2. MIBC patients who refuse or have poor physical condition can not tolerate radical cystectomy. Bladder retention therapy is a reasonable treatment.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

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