膀胱平滑肌肉瘤诊治体会(附4例报告)

Leiomyosarcoma of the urinary bladder:4 cases report and review of the literature

目的：探讨膀胱平滑肌肉瘤的诊断和治疗方法。方法回顾分析2004年至2013年收治的4例膀胱平滑肌肉瘤患者的临床资料。4例患者均有肉眼血尿,其中伴排尿困难1例,伴尿频、尿急、尿痛1例。膀胱镜检见肿瘤位于膀胱顶部1例,膀胱侧壁3例。3例行膀胱部分切除术,1例行根治性膀胱切除术。3例术后 GC方案（吉西他滨＋顺铂）化疗。结果所有患者术后病检均证实为膀胱平滑肌肉瘤。3例为低级别,1例为高级别。患者均获随访,随访时间6∽36个月。1例术后1年内死亡,1例术后2年死亡。2例存活,其中1例为术后6个月,1例术后至今存活3年。结论膀胱平滑肌肉瘤罕见,预后较差,治疗以根治性手术为主,化疗及放疗效果均不理想,多样化的辅助治疗方案可改善其预后。

Objective Discussing the diagnosis and treatment of bladder leiomyosarcoma ac-cording to clinical data and literature review. Methods A retrospective analysis of 4 cases bladder leiomyosarcoma from 2004 to 2013 in our center was performed,including 3 males and 1 female,age from 28 to 72y.All patients had a manifestation of gross hematuria and 1 case with dysuria,another with urinary frequency,urgency and painful urination.All of 4 cases showed no abdominal pain. Both ultrasound and CT scan showed lesions in the bladder.Bladder cystoscopy found the tumor lo-cated in dome for 1 case and in lateral wall for 3 cases.The tumors shaped in cauliflower papillary and extensively wide in base.Only 1 cases was treated with radical cystectomy and 3 with partial cystectomy,of 3 patients received postoperatively GC chemotherapy. Results Pathological diagno-sis confirmed bladder leiomyosarcoma in the cases,low-grade for 3 and high-grade for 1 .All patients were followed up ranging from 6 to 36 months.The median survival time was 24 months. Conclu-sions Leiomyosarcoma of the bladder is a rare genitourinary malignancy with features of rapid pro-gress and poor prognosis.Radical cystectomy is the main treatment.Partial cystectomy and TURBT is not advocated.The effect of chemotherapy and radiotherapy is poor.Diversification of adj uvant treatment programs may improve the prognosis.