膀胱非尿路上皮性恶性肿瘤的诊断与治疗(附14例报告)

Nonurothelial cancer of the bladder(Report of 14 cases)

目的:探讨膀胱非尿路上皮性恶性肿瘤的治疗方法和预后。方法:回顾性分析14例膀胱非尿路上皮性恶性肿瘤的临床资料:男、女各7例,年龄34～86岁,平均72.6岁,临床表现主要为无痛性肉眼血尿、尿频、尿急和排尿困难;辅助检查主要为B超、盆腔CT以及膀胱镜检查加活检;行膀胱全切除术9例,膀胱部分切除术1例,经尿道膀胱肿瘤电切除术(TUBRt)4例。结果:术后病理检查证实膀胱腺癌5例,膀胱鳞癌4例,膀胱小细胞癌3例,膀胱平滑肌肉瘤2例;术后平均存活时间为11.3个月,仅1例患者术后39个月仍存活。结论:膀胱非尿路上皮性恶性肿瘤临床少见,恶性程度较高,预后较差。根治性膀胱全切除术是推荐的首选手术方法,结合不同肿瘤类型的病理特点,新辅助或辅助放化疗可以提高疗效。

Objective： Nonurothelial bladder cancer frequently presents a diagnostic and therapeutic challenge. We review our patients clinical characteristics in order to investigate the therapeutic modalities and its prognosis of nonurothelial bladder cancer. Methods： We review 14 cases in our hospital with nonurothelial bladder cancer. Haematuria was the main clinical presentation; irritative bladder symptoms and dysuria were also seen in these patients. The diagnostic methods included ultrasound, pelvic CT scan and cystoscopy plus biopsies. Results.. Of all 14 patients, 5 were adenocareinoma; 4 were squamous cell carcinoma; 3 were small cell carcinoma and 2 were sat coma. 9 patients were undergone radical cystectomy, 1 patient was performed by partial cystectomy and 4 patients were undergone TURBt The mean survival time was 11.3 months. Only one patient was still alive with 39 months till now. Conclusions： The systematic investigation of most nonurothelial bladder cancer is limited by the rarity of these lesions. Radical cystectomy should be recommended as the first line treatment for these patients. Combinedwith chemotherapy and/or radiation could improve the efficacy of operation.