应用TUR术治疗膀胱癌膀胱全切术后复发性尿道癌

Transurethral resection for urethral recurrence after radical cystectomy in patients with bladder cancer

目的:探讨膀胱癌行膀胱全切术后尿道复发的治疗方法。方法:回顾性分析膀胱癌行膀胱全切术患者216例,其中术后复发尿道癌15例(6.9%),复发平均时间18(3-46)个月。15例患者术后因肉眼血尿(7例)、血性分泌物(3例)及排尿不畅(5例)再次就诊。均经尿道膀胱镜检查及尿道冲洗细胞学检查确诊。尿道镜活检报告为尿道尿路上皮癌,病理分期为T a-T1。15例均行TUR术,术后辅以羟基喜树碱灌注治疗。结果:15例患者术后平均随访36(6-52)个月。其中12例患者健在,未见肿瘤复发及转移;1例术后14个月肿瘤复发,行全尿道切除+尿液转流术,随访至今未见肿瘤再次复发及转移;1例术后8个月肿瘤复发,行全尿道切除+阴道前壁、侧壁、子宫及附件切除+盆腔淋巴结清扫术,术后9个月死于肿瘤多发转移;1例死于心肌梗死。结论:膀胱癌膀胱全切术后复发尿道癌可应用TUR术治疗,临床效果良好且生活质量较高。早期诊断与治疗是保证预后的关键。

Objective：To investigate the treatment of urethral recurrence after radical cystectomy in patients with bladder cancer. Methods： In 216 consecutive patients with radical cystectomy, 15 patients （ 6.9 % ） presented with a urethral recurrence at a median of 18 months（ range 3 to 46 months）. The patients were admitted to hospital with com- plaining of gross hematuria（7 cases ）, hemorrhagic secretion （ 3 cases ） and dysuria （ 5 cases ）. All the patients were confirmed on urethroscope and urethral flushing cytology. All 15 patients were treated by transurethral resection and intraurethral instillation with hydroxycamptothecin. Results： Mean follow - up was 36 months （ 6 - 52months ）. 12 pa- tients survived without recurrence or distant metastatis ; 1 had recurrence 14 months after operation and was cured after the second operation of urethrectomy and urinary diversion ; 1 had recurrence 8 months after the operation, the patient underwent the radical urethrectomy, vaginectomy, hysterectomy, adnexectomy and pelvic lymphyadenectomy after- wards, but she died of multiple metastasis 9 months after the second operation ; 1 died of myocardial infarction. Con- clusion ： Transurethral resection and intraurethral instillation treatment could be applied to the urethral recurrence after radical cystectomy and could maintain the quality of life.