膀胱癌侵犯前列腺及精囊的危险因素研究

发布时间：2018-07-07 19:55

本文选题：膀胱癌 + 前列腺侵犯　；参考：《昆明医科大学》2014年硕士论文

【摘要】：目的：通过对膀胱癌侵犯前列腺及精囊的危险因素研究,为保留前列腺及精囊的根治性膀胱切除术的开展寻找临床依据。方法：收集2013年5月至2014年4月,在昆明医科大学第二附属医院接受开放或腹腔镜根治性膀胱切除术的78例男性膀胱癌患者的病理资料。对根治术后的膀胱、前列腺标本进行系统病理切片检查,前列腺标本病理切片采用每间隔5mm做多个冠状切面至前列腺尖部。通过对患者根治性膀胱切除后标本的病理研究,即患者的年龄、肿瘤的数目、分级、分期、大小、部位、肿瘤距膀胱颈口的最近距离及是否有淋巴结转移,分析上述危险因素与前列腺和精囊受侵犯的相关性。结果：78例膀胱癌患者的平均年龄为61.23±11.46岁,9例(11.5%)前列腺被膀胱癌侵犯,3例(3.85%)侵犯精囊,13例(16.7%)发现偶发前列腺腺癌。膀胱癌侵犯前列腺的危险因素经统计学分析,结果得出膀胱肿瘤部位、肿瘤距膀胱颈口的最近距离、肿瘤分级、肿瘤分期、淋巴转移情况等指标有统计学意义(P0.05),而年龄、肿瘤大小、肿瘤数目则无统计学意义(P0.05)。肿瘤位于膀胱三角区或颈部、多发肿瘤、肿瘤直径大于4cm、淋巴结阳性是膀胱肿瘤侵犯精囊的危险因素。13例膀胱癌伴偶发前列腺腺癌的患者的Gleason评分均小于7分,且仅在病理切片中发现微小或局灶区域的高分化前列腺腺癌,其危险因素为高龄和分期高的膀胱癌(P0.05)。结论：1、肿瘤位于膀胱颈部或三角区、肿瘤距膀胱颈口的距离较近、高分级、T3期以上的肿瘤以及淋巴阳性是膀胱肿瘤侵犯前列腺的高危因素。 2、肿瘤位于膀胱三角区或颈部、多发肿瘤、肿瘤直径大于4cm、淋巴结阳性是膀胱肿瘤侵犯精囊的危险因素。 3、膀胱肿瘤患者的年龄及T2期以上的肿瘤是偶发前列腺癌的危险因素。 4、为了保证手术后的效果,在实施保留前列腺的根治性膀胱切除术时应进行严格筛选,可将年龄相对较小、肿瘤不位于膀胱颈部或三角区、距离膀胱颈口较远、肿瘤直径小于4cm、T2期以下的肿瘤、低分级和淋巴结阴性作为实施保留前列腺的根治性膀胱切除术的适应证。
[Abstract]:Objective: to study the risk factors of bladder cancer invasion of prostate and seminal vesicle, and to find the clinical basis for radical cystectomy for preserving prostate and seminal vesicle. Methods: from May 2013 to April 2014, 78 male patients with bladder cancer underwent open or laparoscopic radical cystectomy in the second affiliated Hospital of Kunming Medical University. The specimens of bladder and prostate after radical operation were examined by systematic pathological sections. The 5mm sections were used to make multiple coronal sections to the apex of the prostate. After radical cystectomy, the patient's age, tumor number, grade, stage, size, location, the nearest distance from the bladder neck and lymph node metastasis were studied. To analyze the correlation between the above risk factors and the invasion of prostate and seminal vesicle. Results the average age of 78 patients with bladder cancer was 61.23 卤11.46 years old (9 / 78) (11.5%). The prostate was invaded by bladder cancer in 3 cases (3.85%) and the seminal vesicle in 13 cases (16.7%). The risk factors of bladder cancer invading the prostate were statistically analyzed. The results showed that the location of bladder tumor, the closest distance from the tumor to the bladder neck, tumor grade, tumor stage, lymphatic metastasis and so on were statistically significant (P0.05). Tumor size and tumor number were not statistically significant (P0.05). The tumor was located in the trigonometry or neck of the bladder with multiple tumors. The diameter of the tumor was more than 4 cm. The positive lymph node was the risk factor of bladder tumor invading seminal vesicle. The Gleason score of 13 cases of bladder cancer with incidental prostate adenocarcinoma was less than 7 points. Only small or focal areas of well-differentiated prostate adenocarcinoma were found in pathological sections, and the risk factors were advanced bladder cancer (P0.05). Conclusion the tumor is located in the neck or triangle of the bladder, and the distance from the tumor to the neck of the bladder is close. High grade T 3 tumor and lymphatic positive are the high risk factors of bladder tumor invading the prostate. 2. The tumor is located in the triangle or neck of the bladder, and has multiple tumors. The diameter of tumor is more than 4 cm, the positive lymph node is the risk factor of bladder tumor invading seminal vesicle. 3. The age of bladder tumor patients and the tumor over T2 stage are the risk factors of incidental prostate cancer. After the operation, When performing radical cystectomy to preserve the prostate, strict screening should be carried out. Tumors with a relatively young age, which are not located in the neck or triangle of the bladder, are farther away from the neck of the bladder, and the diameter of the tumor is less than 4 cm or below T2. Low grade and negative lymph nodes are indications for prostate-preserving radical cystectomy.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

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