原发性精囊癌的诊断和治疗（附4例报告）

The treatment and diagnosis of primary seminal vesicle carcinoma ： report of 4 cases

目的探讨原发性精囊癌的临床表现、诊断及治疗。方法回顾性分析4例原发性精囊癌患者的临床症状、体征、检查结果、手术方案及术后治疗。1例行双侧精囊连同膀胱、前列腺、直肠根治性切除术。2例行精囊、部分膀胱、前列腺切除术。1例行精囊、膀胱、前列腺、输尿管下段、直肠前壁切除术及回肠膀胱术。结果2例患者术后随访5年未见复发与转移，1例术后2年死于结肠癌，1例术后随访3个月未见复发与转移。结论原发性精囊癌的临床表现为血精或血尿，下尿路梗阻症状，大便性状与次数的改变，早期症状不明显，患者血清中前列腺特异抗原（PSA）、CEA阴性，细胞角蛋白（CK）阳性。治疗主要根据肿瘤侵及的范围采取相应的手术方式予以切除，术后应加以联合化疗。

Objective To approach the clinical presentation, treatment and diagnosis of primary seminal vesicle carcinoma. Methods The records of 4 patients who diagnosed seminal vesicle carcinoma were retrospectively reviewed, including the symptoms signs and examination results as well as operation program, postoperative therapy. Considered to the literature reports. Bilateral seminal vesicles, bladder, prostate and rectum were totally removed in one case. Seminal vesiculectomy and partial cystoprostotectomy were performed in 2 cases, and the another one, bilateral lower ureterectomy and ileum substitute bladder was be done. Results Followed up for 3 months to 5 years, and no recurrence had been observed so far, one died of colon cancer after 2 years. Conclusions Early symptoms of primary seminal vesicle carcinoma are unobvious, so that early diagnosis of seminal vesicle carcinoma is difficult and the misdiagnosis is so usually. Thus, accurate recognition is important for early diagnosis. Radical surgery appears to offer the best chance and different approaches can be selected according to tumor stage and invasive condition of the circumambient organ. Comprehensive treatment like hormonal therapy, along with the 5-fluorouracil, paclitaxel, and oxaliplatin chemotherapy regimen appears to be effective against adenocarcinoma.