原发性T_1G_3膀胱移行上皮细胞癌的保守性手术治疗(附40例报告)

TUR for the treatment of T1G3 transitional cell carcinoma of bladder

为探讨原发性Ｔ１Ｇ３膀胱移行上皮细胞癌保守治疗的效果，近１１年来采用经尿道电切膀胱肿瘤（ＴＵＲＢｔ）辅以膀胱内丝裂霉素Ｃ及噻替哌化学疗法治疗４０例原发性Ｔ１Ｇ３膀胱移行上皮细胞癌病人。平均随访时间４７．８个月（７～１３１个月）。４０例病人中７例（１７．５％）术后平均２１个月（５～３３个月）复发浅表性肿瘤。１例因肿瘤复发于后尿道和膀胱三角区而施行根治性膀胱切除及可控性右半结肠代膀胱术，１例肿瘤复发距输尿管开口较近而作膀胱部分切除术。另１例出院后５个月则因脑血管意外死亡。至本研究结束为止，本组病人的５年和１０年无癌生存率分别为８２．４％和６６．７％（ＫａｐｌａｎＭｅｉｅｒ分析）。结论：为提高病人的无癌生存率和生活质量，对符合保守性手术疗法条件的原发性Ｔ１Ｇ３膀胱移行上皮细胞癌采取ＴＵＲＢｔ辅以膀胱内化疗作为最初的治疗，是一个合理的选择。

From March 1986 to May 1997, 40 consecutive cases of T1G3 bladder transitional cell carcinoma were treated by transurethral resection (TUR) with adjuvant intravesical chemotherapy using mitomycin C or Thiotepa alone or alternatively. The patients have been followed up for 7～131 months with a mean of 47.8 months. Reccurrence of the tumor was noted in 7(17.5%) out of the 40,5～33 months after TUR with a mean of 21 months after the surgery. The 5years and 10year tumor free survival rates have been 82.4%and 66.7%respectively. TUR with adjuvant intravesical chemotherapy was recommented for the initial treatment of T1G3 bladder transitional cell carcinoma. 