脐尿管癌的诊治和预后分析

Diagnosis and treatment and prognosis of urachal carcinoma

目的探讨脐尿管癌的诊治措施、疗效及预后分析。方法回顾性分析14例脐尿管癌患者的临床资料、治疗方案和随访结果。结果本组患者肿瘤直径为2.5～6.5cm,均侵犯膀胱,肿瘤与盆腔固定1例。11例行扩大膀胱部分切除术;2例行根治性膀胱全切+改良腹膜外输尿管皮肤乳头状造口术;1例探查因肿瘤固定盆腔未能切除,给予肿瘤内注入氟尿嘧啶、顺铂处理,并行盆腔放疗。病理检查结果为黏液性腺癌10例,移行上皮癌2例,鳞癌1例。8例出现术后局部复发和远处转移而行M-VAC(氨甲喋呤、长春新碱、阿霉素和顺铂)方案化疗。包括未能切除者在内共6例行放疗,剂量55～75Gy。术后随访5～67个月,平均35个月,未能手术切除者放疗后15个月死于全身多处转移;11例行膀胱部分切除者中2例术后25、29个月死于远处转移,另9例目前仍无瘤生存;2例行膀胱全切者分别为腺癌和鳞癌患者,鳞癌患者术后6个月死亡。结论脐尿管癌发病位置隐匿,术前诊断较为困难,螺旋CT是最准确的检查方法 ;治疗方法主要是行扩大性膀胱部分切除术;本病的预后很差,临床分期与预后密切相关,综合治疗可应用于复发转移者。

[Objective]To approach the diagnosis, treatment , curative effect and prognosis of the Urachal Carcinoma. [Methods]The clinical data, therapeutic regimen and the results of the prognosis of 14 cases of urachal carcinoma treated from June 2006 to January 2008 were reviewed and analyzed. [Results]The diameter of the tumor was between 2.5 cm to 6.5cm, and all the tumor encroached the bladder. Of 14 cases, 11 cases were treated by extensive partial cystectomy; 2 cases received radical cystectomy and modified cutaneous ureterostomy; 1 case was injected Fluorouracil, Cisplatin in the tumor, and received the pelvic irradiation, as the tumor fixed to the cavitas pelvis and could not be resected. After the pathological examination, we found that of 14 cases, 10 cases were mucinous adenocarcinoma, 2 cases were transitional epithelial cancer and 1 case was squamous cell carcinoma. 8 cases who had postoperative local recurrence and distant metastasis received M-VAC chemotherapy （MTX, VCR, ADR, Cisplatin）. The other 6 cases received radiotherapy （dose between 55～75 Gy）,. The postoperative follow-up of 5 to 67 months （Mean time was 35 month） revealed that： the patient received radiotherapy whose tumor could not be resectd died after 15 months because of multiple metastatic sites in the whole body; of the 11 cases who received extensive partial bladder excision, 2 cases died after 25, 29 months as distant metastasis, and the other 9 cases were tumorfree survival; And the other 2 cases received radical cystectomy were adenocarcinoma and squamous cell carcinoma, and the latter died 6 months after operation.[Conclusion] Urachal carcinoma is difficult to diagnose before operation due to its special anatomical position. Spiral CT was the most accurate method diagnose; the extensive partial bladder excision was the major therapy. The prognosis of this desease was bad, and the clinical stage was closely related to the prognosis. The combined therapy could be used to the patients who were recurrence and/or metastasis.