高龄膀胱癌10例全膀胱切除术实践与体会

The practice and experience of radical cystectomy in patients older then 75 years(report of 10 cases)

目的探讨高龄(≥75岁)浸润性膀胱癌患者行全膀胱切除术的可行性及疗效。方法1995年1月至2003年1月收治高龄(≥75岁)浸润性膀胱癌行全膀胱切除术患者10例,均为男性,平均年龄76岁。从手术时间、术中输血、术后并发症、生存率等方面与同期40例浸润性膀胱癌(<75岁,对照组)行全膀胱切除术患者进行比较。结果高龄组平均手术时间360min,平均术中输血1500ml,平均术后住院时间20d,对照组分别为316min,1200ml,16d,两组比较差异无统计学意义(P>0.05)。高龄组和对照组术后近期并发症分别为6例(60%)、10例(25%),P<0.05。高龄组7例获随访,1、5年生存率分别为71.4%、57.1%。对照组40例获得随访,1、5年生存率分别为90.0%,65.0%。高龄组患者1年生存率明显低于对照组(P<0.05),而5年生存率比较差异无统计学意义(P>0.05)。结论全膀胱切除术可以安全地应用于适当选择的高龄患者,年龄不应成为高龄浸润性膀胱癌患者行根治性全膀胱切除术的排除标准。

Objective To evaluate the feasibility and efficacy of radical cystectomy in elderly patients （≥75 years） with invasive bladder carcinoma. Methods This series included 10 male cases of bladder carcinoma older than 75 years who had undergone radical cystectomy, and 40 cases younger than 75 years who had also undergone radical cystectomy for invasive bladder carcinoma from January 1995 to January 2003. The operative time, intraoperative blood transfusion,postoperative complications and survival rate were compared between the 2 groups. Results The mean operative time was 360 min in older group and 316 min in control group.The volume of blood transfusion was 1500ml in older group and 1200 ml in crotrol group.The mean hospital stay was 20 d in older groub and 16d in control group.There was no significient difference in these parameters between 2 groups （P〈0.05）. Complications shortly after operation occurred in 6 cases （60%） in older group and 10 cases（25%） in control group（P〈0.05）. Follow-up was available in 7 cases （60%）of older group with 1- and 5-year survival rates of 71.4% and 57.1% respectively; while 40 cases（25%） in control group were followed up with 1-and 5-year survival rates of 90% and 65% respectively. The 1-year survival rate in older group was significantly lower than in control group（P〈0.05）, while there was no obvious difference in 5-years survival rate between the 2 groups（P〈0.05）.Conclusion With careful selection, radical cystectomy can be safely performed in elderly patients with invasive bladder carcinoma.