肌层浸润性膀胱癌保留膀胱综合治疗的可行性分析

Feasibility analysis of comprehensive bladder retention therapy for muscular infiltrating bladder carcinoma

【目的】探讨肌层浸润性膀胱癌保留膀胱综合治疗的可行性分析。【方法】回顾性分析T2肌层浸润性膀胱癌患者81例,按照治疗方式的不同,分为保留膀胱组(partial cystectomy,PC)[59例,采用经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)或行膀胱部分切综合治疗]与膀胱全切组(radical cystectomy,RC)(22例,采用根治性膀胱切除术治疗)。比较两组的手术情况(术中的出血量、手术时间、住院时间、并发症),统计患者肿瘤的复发率,5年生存率(overall survival,OS),肿瘤特异性生存率(cancer specific survival,CSS)及生活质量评分。分析两种治疗方式的疗效。【结果】两组共81例患者手术均顺利完成。PC组与RC组平均手术时间分别为[(59.92±31.41)min与(210.45±41.23)min],平均术中出血量分别为[(35.25±30.39)ml与(954.55±595.00)min],两组比较,差异均具有统计学意义(P<0.05)。两组患者术后并发症差异有统计学意义(P<0.05)。两组患者术后随访,PC组出现26例复发,复发率为44.06%,RC组出现4例局部复发,复发率为18.18%,两组患者复发率有统计学意义(P=0.032<0.05)。PC组与RC组生活质量评分分别为(46.20±4.08)分与(33.32±1.29)分,两组患者数据具有统计学意义(P<0.05)。PC组与RC组患者5年总生存率分别为61.02%与63.63%,5年肿瘤特异性生存率分别为74.58%与81.81%。两组患者OS、CSS差异无统计学意义。【结论】保留膀胱治疗与根治性膀胱切除术均可有效治疗肌层浸润性膀胱癌,但保留膀胱治疗为复发后进行二次手术保留了一定的机会,为肌层浸润性膀胱癌更有效的、个体化的治疗措施。

【Objective】To analyze the feasibility of comprehensive bladder sparing therapy for muscular invasive bladder cancer.【Methods】A retrospective analysis of 81 patients with T2 muscle layer invasive bladder cancer was carried out.According to the different methods of treatment,they were divided into PC group(59 cases under going transurethral bladder tumor electricity cut method(TURBT)or line cut part(PC)comprehensive treatment)and RC group(22 casesundergoing radical cystectomy).The operation conditions(intraoperative blood loss,operation time,length of stay,complications)between the two groups were compared,and the tumor recurrence rate,5-year survival rate(OS),tumor-specific survival rate(CSS)and quality of life score of the patients were calculated.The therapeuticefficacy of the two treatmentmehthods was analyzed.【Results】The operation of 81 patients in both groups was completed successfully.The mean operative time in PC group and RC group was(59.92±31.41)min and(210.45±41.23)min,and the mean intraoperative blood loss was(35.25±30.39)ml and(954.55±595.00)min,respectively.The difference between the two groups was statistically significant(P<0.05).The difference of postoperative complications between the two groups was statistically significant(P<0.05).In the postoperative follow-up of two groups,there were 26 cases of recurrence in the PC group,with a recurrence rate of 44.06%,and 4 cases of local recurrence in the RC group,with a recurrence rate of 18.18%.The recurrence rate of patients in the two groups was statistically significant(P=0.032<0.05).The quality of life scores of PC group and RC group were(46.20±4.08)and(33.32±1.29),respectively,and the data of patients in the two groups were statistically significant(P<0.05).The 5-year overall survival rate of patients in PC group and RC group was 61.02%and 63.63%,respectively,and the 5-year tumor-specific survival rate was 74.58%and 81.81%,respectively.There was no significant difference in OS and CSS between the two groups.【Conclusion】Comprehensive bladder sparing therapy and radical cystectomy can be effectivein the treatment of muscular invasive bladder cancer.However,bladder sparing therapy retains certain opportunity for the second surgery after recurrence.Therefore,bladder sparing therapy will provide more effective and individualized treatment measures for patients with muscular invasive bladder cancer.