膀胱腺癌的诊治：附12例报告

Adenocarcinoma of Urinary Bladder:a Report of 12 Cases

目的:探讨膀胱腺癌的诊治方法。方法:回顾性分析1996—2005年诊治12例膀胱腺癌患者的临床资料。结果:12例患者中男性7例,女性5例;年龄38～78岁;11例因血尿、尿频等尿路症状就诊,1例因其他疾病就诊时发现。B超检查均提示膀胱内占位;膀胱镜检发现肿瘤直径1.0～8.5 cm。5例首次就诊即行根治性全膀胱切除术;5例行膀胱部分切除术,4例术后复发,其中2例行根治性全膀胱切除术,2例再次行扩大膀胱部份切除术;2例患者行经尿道膀胱肿瘤电切术,其中1例术后1个月原位复发,行CT检查证实为脐尿管癌,行扩大膀胱部份切除,脐尿管切除术;1例首次术后病理提示膀胱移行细胞癌,术后3次复发,第3次手术后病理提示膀胱印戒细胞癌。10例患者获得随访,随访2～8年。2年生存率60%(6/10),5年生存率33%(2/6)。首次行全膀胱切除患者2年生存率75%(3/4),5年生存率67%(2/3);首次行膀胱部份切除患者2年生存率50%(2/4),5年生存率33%(1/3);首次行经尿道膀胱肿瘤电切术患者2例,其中脐尿管癌1例术后随访4年存活,未复发;移行细胞癌多次复发转变为印戒细胞癌1例术后随访2年存活。结论:膀胱腺癌是一种高度恶性肿瘤,预后差,早期积极的综合治疗对延长患者生存时间有重要意义。

Objective： To discuss the clinical characteristics of adenocarcinoma in urinary bladder. Methods：Clinical data of 12 patients with adenocarcinoma in urinary bladder treated in our hospital from 1996 to 2005 were analyzed retrospectively. Results： The age of these patients was from 38 to 78 years, Hemaurine was found in 11 patients. The diameter of tumor was from 1, 0 cm to 8.5 cm, Radical cystectomy were performed in 5 cases and partial cystectomy were performed in 5 cases. Transurethral resction were performed in 2 cases in which 1 cases was diagnosis as urachal adenocarcinoma, the others was diagnosed as transitional cell carcinoma at first time and recurred 3 times in follow 3 years. Signet-ring cell adenocarcinoma was found at last time. 10 cases were followed from 1 to 8 years. The 2-year and 5 year survival rates was 60% （6/10）and 33% （2/6）,respectively. The 2-year and 5 year survival rates was 75 % （3/4） and 67%（2/3）, respectively after radical cystectomy. Furthermore, the 2-year and 5-year survival rate was 50% （2/4）and 33 % （1/3） respectively after partial cystectomy, Conclusion：Comprehensive therapy is important in treating adenocarcinoma of urinary bladder because of its high risk and poor prognosis.