膀胱移行细胞癌伴前列腺癌的诊断与治疗(附5例报告)

Diagnosis and treatment of coincident vesical transitional cell carcinoma and prostate cancer:A report of 5 cases

目的:提高膀胱移行细胞癌伴前列腺癌的诊治水平。方法:对5例膀胱移行细胞癌伴前列腺癌患者的临床资料进行分析。结果:5例患者平均年龄66.2岁,术前均经膀胱镜检查及活检病理证实为膀胱移行细胞癌(均为II至III级)。1例术前既往诊断为前列腺癌,4例术后病理证实为前列腺癌,前列腺癌Gleason分级4级至6级;2例行膀胱全切,输尿管皮肤造口术。1例行膀胱前列腺全切加回肠膀胱术。1例行径尿道膀胱肿瘤切除术,1例因身体原因仅行姑息性输尿管皮肤造口术。术后随访8个月至26个月。1例术后20个月后死于全身广泛转移;1例随访14个月带瘤存活;余3例经胸片、CT、同位素和PSA等检查未见肿瘤复发或转移。结论:膀胱癌患者,如合并的前列腺癌,如果重视不够容易被漏诊。血清PSA测定、前列腺直肠指诊、经直肠前列腺B超检查、活检及膀胱镜检查是诊断膀胱移行细胞癌伴前列腺腺癌的主要方法,当诊断膀胱癌同时存在局限性前列腺癌时,治疗方案应根据膀胱癌和前列腺癌的分期、分级综合而定。膀胱移行细胞癌伴前列腺癌并不提示预后不良。

Objective：To improve the diagnosis and treatment of coincident vesical transitional cell carcinoma （VTCC） and prostate cancer. Methods：We analyzed the clinical data of 5 cases of coincident VTCC and prostate cancer. Results：The 5 patients,at the mean age of 66.2 years,were diagnosed as having grade Ⅱ-Ⅲ VTCC by cystoscopy and biopsy,1 with a history of prostate cancer,and the other 4 with prostate cancer confirmed by postoperative pathological examination. Two of the patients were treated by radical cystoprostatectomy,1 by radical cystoprostatectomy and ileum conduit surgery,1 by transurethral resection of bladder tumor,and the other 1 by palliative ureterocutaniostomy due to cardiopulmonary problems. The follow-up lasted 8-26 months. One of them died of diffused metastasis 20 months after surgery,1 survived with the tumor untreated,and the other 3 remained tumor free. Conclusion：Coincident VTCC and prostate cancer is easy to be missed in diagnosis. PSA detection,rectal palpation,transrectal ultrasonography,biopsy,and cystoscopy are the main diagnostic options for this disease. Its treatment should be based on the classification and clinical staging of the two cancers. Coincident VTCC and prostate cancer does not suggest poor prognosis.