继发于结直肠的膀胱转移性腺癌的诊断和治疗

Diagnosis and therapy of secondary bladder adenocarcinoma originating from colon and rectum

目的：探讨继发于结直肠的膀胱转移性腺癌的临床特点，提高对此病的诊治水平。方法：总结2004年6月-2012年3月我们共收治的11例继发于结直肠的膀胱转移性腺癌的诊治结果。原发癌包括：直肠癌6例，乙状结肠癌4例，降结肠、乙状结肠及直肠多发癌1例。其中8例原发癌术后出现膀胱转移时间为6～50个月，平均20个月；3例同时发现原发病变及膀胱转移病变。结果：lO例患者接受随访，1例失访，随访时间为1～42个月，平均18．7个月。死于全身多发转移6例，从发现膀胱转移癌到死亡间隔时间为6～28个月，平均17．2个月，其余4例均仍在随访中。结论：继发于结直肠的膀胱转移性腺癌少见，预后差。早期诊断困难，免疫组化有助于鉴别原发性膀胱腺癌和继发于结直肠的膀胱转移性腺癌。

Objective： To study the clinical features of secondary bladder adenocarcinoma originating from co- lon and rectum and to improve the diagnosis and treatment of this disease. Method： Eleven cases of secondary bladder adenocarcinoma originating from colon and rectum were treated from June 2004 to March 2012. The data were reviewed and analyzed. Primary cancers included six cases of rectal cancer, four cases of sigmoid cancer, one case of multiple cancer of descending colon, sigmoid and rectum. Eight cases were found secondary bladder adeno- carcinoma originating from the colon and rectum 6-50 （mean, 20） months after the surgery of primary cancer. Three cases were discovered primary cancer and secondary bladder adenocarcinoma simultaneously. Result： Except one case, all patients were followed up 1-42 （mean, 18.7） months. Six cases died of multiple metastasis, which the time of detection of secondary bladder adenocarcinoma to death was 6-28 （mean,17.2） months. The rest four cases were still under follow-up. Conclusion： Secondary bladder adenocarcinoma originating from colon and rectum is rare. However, it has a poor prognosis. Immunohistocbemical examination is useful to distinguish primary ade- nocarcinoma of the urinary bladder from secondary involvement by colorectal adenocarcinoma.