全膀胱切除和原位新膀胱术治疗女性浸润性胱膀癌患者(附8例报告)

Total Cystectomy and Neobladder for Women Patients with Invasive Bladder Cancer: a Report of Eight Cases

背景与目的全膀胱切除和原位新膀胱广泛用于治疗男性浸润性膀胱癌,效果良好,但用于女性浸润性膀胱癌的经验很少。本研究的目的是探讨女性全膀胱切除和乙状结肠原位新膀胱的临床效果。方法回顾性分析2002年1月至2003年10月中山大学肿瘤防治中心应用全膀胱切除和乙状结肠原位新膀胱术治疗的8例女性浸润性膀胱癌的临床资料。结果手术均获成功。随访6～24个月(平均18个月),6例无瘤生存,2例分别于术后6个月和12个月出现盆腔复发。全部患者均能自主排尿。4例昼夜完全控尿,另4例白天完全控尿,夜间有少许漏尿。1例术后3个月发现肾输尿管轻度积水,观察3个月后自然消退。血电解质和肾功能均正常。结论女性膀胱癌患者行全膀胱切除和乙状结肠原位新膀胱术后,肿瘤控制及新膀胱功能良好,但夜间控尿能力较差。

BACKGROUND & OBJECTIVE: Although total cystectomy plus neobladder is widely used, with good outcome, to treat men patients with invasive bladder cancer, the experience of treating women patients with the same therapy is limit. This study was designed to investigate the outcome of total cystectomy plus sigmoid neobladder for women patients with invasive bladder cancer. METHODS: Clinical data of 8 women with invasive bladder cancer, who underwent total cystectomy plus sigmoid neobladder from Jan. 2002 to Oct. 2003 in Cancer Center of Sun Yat-sen University, were retrospectively analyzed. RESULTS: The operations were technically successful in all cases. The mean follow-up was 18 months (ranged 6-24 months). Six patients survived disease-freely;2 developed pelvic metastasis 6 and 12 months after operation respectively. All patients could actively urinate, 4 were continent day and night, 4 were continent at daytime with mild nocturnal incontinence. Mild hydronephrosis was detected in 1 patient 3 months after operation, which disappeared spontaneously 3 months later. Renal function and serum electrolytes were normal in all cases. CONCLUSIONS: Total cystectomy plus sigmoid neobladder could manage invasive bladder cancer in women patients, and the new bladders function well. But night continence in women patients is not as good as that in men patients.