脐尿管癌14例临床分析

Clinical Analysis of 14 Cases of Urachal Carcinoma

背景与目的:脐尿管癌临床少见。本研究旨在探讨脐尿管癌的诊断与治疗方法,以提高其疗效。方法:回顾性分析中山大学肿瘤防治中心及中山大学附属第一医院1994年5月至2007年4月收治的14例脐尿管癌临床资料。结果:本组患者最常见的临床症状为血尿和膀胱刺激症状,膀胱镜检查主要表现为膀胱顶部宽基底肿物,影像学检查征象常见膀胱顶前壁与腹壁之间质软组织肿块影,常浸润膀胱壁。本组病例腺癌13例,恶性间质细胞瘤1例。7例行扩大性膀胱部分切除术患者中,1例术后24个月局部复发,6例随访14～120个月,中位随访42个月无复发;3例行全膀胱切除+尿流改道术,其中2例分别随访16个月和84个月无复发,1例术后3个月死于手术并发症;1例在外院行膀胱部分切除术,术后10个月局部复发;3例晚期未切除者行化疗,2例肿瘤无进展生存7个月和8个月,1例化疗后6个月死于肿瘤。本组病例1年、5年生存率分别为85.7%和61.2%。结论:扩大性膀胱部分切除术是值得推荐的手术方式。首次手术彻底切除肿瘤及对晚期及术后复发转移患者积极的综合治疗,是提高脐尿管癌疗效的关键。

BACKGROUND ＆ OBJECTIVE： Urachal carcinoma is a rare malignancy. This study was to summarize our clinical experience in the diagnosis and treatment of urachal carcinoma. METHODS： Fourteen cases of urachal carcinoma treated from May 1994 to April 2007 at Cancer Center and The First Affiliated Hospital of Sun Yat-sen University were retrospectively reviewed and analyzed. RESULTS：The most common complaints of the 14 patients were hematuria and irrigative bladder symptoms. Cystoscopy mainly revealed broad-based tumors located at the dome of the bladder. Soft-tissue masses between the bladder dome and the abdominal wall were detected by imaging examinations; the wall of the bladder was often invaded, Thirteen patients were found adenocarcinoma, the other one was malignant stromal cell tumor. Seven patients underwent extensive partial excision of the bladder, among which one case developed local recurrence 24 months after operation, while the other six cases were followed up for 14-120 months, with a median follow-up of 42 months without recurrence. Three patients underwent radical bladder resection and urinary diversion, two of which were followedup for 16 months and 84 months respectively without recurrence, while the other one died from surgical complications 3 months after operation. One case underwent partial cystectomy at another hospital developed recurrence 10 months after operation. Three advanced cancer patients received chemotherapy, two of which achieved progression free survival for seven and eight months respectively, while the other one died three months after chemotherapy. The one- and five-year survival rates were 85.7% and 61.2%, respectively. CONCLUSIONS： Extensive partial excision of the bladder is recommended for urachal carcinoma. Radical removal of the tumor during the first treatment and comprehensive therapies for advanced cancer patients and patients with recurrence or metastasis after operation are critical to improve the treatment efficacy of urachal carcinoma.