膀胱癌开放术后腹壁切口种植转移的治疗体会

Implantation Metastasis to Abdominal Incision After Bladder Partial Cystectomy for Bladder Carcinoma

目的：探讨膀胱癌开放手术后腹壁切口种植转移患者的诊疗效果。方法：我院于1983年—2005年5月共收治膀胱癌术后腹壁切口种植转移患者8例。其中5例为移行细胞癌（1例为G2肿瘤，4例为G3肿瘤），1例为移行细胞癌合并骨化生，1例为膀胱印戒细胞癌，1例为膀胱乳头样腺癌。采用膀胱切除加腹壁转移灶切除2例，经尿道膀胱肿瘤电切术（TURBT）加腹壁转移灶切除1例，尿流改道加化疗1例，腹壁转移灶切除1例，单纯放疗或化疗2例，放弃治疗1例。结果：8例随访已死亡5例，生存时间为（3～16）个月。3例存活者随访（4～12）个月，未见复发。结论：膀胱癌术后腹壁切口种植转移癌一般分化差，或合并其他癌。膀胱全切加肿瘤切除，辅助放化疗能延长患者生存期，但预后差。

Objective： To understand the diagnosis, treatment, and prognosis of implantation metastasisto abdominal incision after open operation for bladder carcinoma. Methods： 8 cases of implantation metastasis to abdominal incision after bladder partial cystectomy for bladder carcinoma encountered from 1983 to May 2005 were studied. Of them, there were 5 transitional cell carcinomas, 1 transitional cell carcinoma with squamous carcinoma, 1 papillary adenocarcinoma, and 1 bladder signet - ring cell carcinoma. Results： Two cases treated with total cystectomy with resection of metastasis, 1 whit TUBBT with resection of metastasis, 1 with urinary diversion with chemotherapy. 1 was treated with resection of metastasis, and 2 with chemotherapy and/or radiotherapy alone. 5 cases died after （4 -16） months survival times; others were still alive following up （4 -12） months and not recurrence. Conclusions： The differentiation of the cancer cells in implantation metastasis is usually bad and often accompanied by squamous or adenocaminoma. Total cystectomy with resection of the metastasis followed by the chemotherapy and/or radiotherapy might prolong the survival time, but the prognosis is usually poor.