宫颈癌综合治疗后继发性膀胱癌的临床特点观察

Clinical features of secondary urotheial cell carcinoma after comprehensive treatment for cervix cancer

目的探讨宫颈癌综合治疗后继发性膀胱癌（简称继发性膀胱癌）的临床特点及治疗策略。方法对6例继发性膀胱癌患者的临床症状、辅助检查、病理类型、治疗方法及结果进行回顾性分析。结果膀胱镜见肿瘤水草样、蒂细1例；乳头样、无蒂3例；片状2例。2例行正电子发射断层显像／）（线计算机体层成像（ positron emission computed tomography/computed tomogra-phy, PET/CT ）显像，膀胱区可见放射性明显浓聚。治疗方法经尿道膀胱肿瘤电切3例，膀胱部分切除术2例，根治性膀胱切除＋回肠导管术1例。电切患者术后行表柔比星膀胱灌注化疗；膀胱部分切除术患者术后均行吉西他滨＋顺铂方案静脉化疗。随访时间26～72月，1例因膀胱局部复发行经尿道膀胱肿瘤电切术，无瘤生存至今；2例分别于术后16月及26月发现全身多发转移。随访期患者无瘤生存率66．7％。结论继发性膀胱尿路上皮癌与原发性膀胱尿路上皮癌在临床症状、辅助检查、病理类型及预后等方面都有所差别。宫颈癌放射时应加强对膀胱的保护，减少继发性膀胱癌的发生。

Objective To explore the clinical features and treatment strategies of secondary urotheial cell carcinoma after comprehensive treatment for pelvic cancer. Methods The clinical symptoms, auxiliary examination, pathological type, treatment, and prognosis of 6 patients with secondary urotheial cell carcinoma were retrospectively analyzed. Results Cystoscopic results showed that 1 case was aquatic growth, 3 papillary and 2 sessile. 2 cases took positron emission computed tomography/computed tomography and the radioactive uptake was visible in bladder region. 3 patients were treated with transurethral resection of bladder tumor （TU/BT） and epirubicin injection therapy, while the others with partial cystectomy or radical cystectomy plus chemotherapy. The patients were followed up 26 to 72 months. Two patients developed supraclavicular lymph node and liver metastasis 16 and 26 months after operation, respectively. TURBT was performed in 1 patients because of local relapse. The disease-free survival rate was 66.7% in follow-up phase. Conclusions There are differences in clinical symptoms, auxiliary examination, pathological type, and prognosis between primary and secondary urotheial cell carcinoma. In case of secondary urotheial cell carcinoma, the protection of bladder should be strengthened in the radiotherapy of cervical cancer.