膀胱癌肉瘤诊疗体会(附3例报告)

Carcinosarcoma of the urinary bladder:report of three cases

目的：探讨膀胱癌肉瘤的诊断及治疗方法。方法：回顾性分析我院2005年～2012年收治的3例膀胱癌肉瘤患者的临床资料,3例患者均以全程无痛肉眼血尿为首发症状,伴排尿困难2例,尿频、尿急1例,膀胱镜检示肿瘤发生于膀胱左侧壁2例,膀胱顶底部1例。3例患者中1例行经尿道膀胱肿瘤电切术（TURBT）,1例行全膀胱切除术＋回肠膀胱术,1例行膀胱全切术＋双侧输尿管皮肤造口术。结果：所有患者术后病理均证实为膀胱癌肉瘤,3例均为高级别。患者术后均获随访,随访时间10～36个月,1例术后10个月死亡,1例术后2年死亡。1例术后至今存活3年。结论：膀胱癌肉瘤是一种少见的高度恶性的膀胱肿瘤,根治性膀胱切除术是主要的治疗方式,术后放化疗效果均不理想,预后差。

Objective：To discuss the diagnosis and treatment of bladder carcinosarcoma.Method：A study of three cases of bladder carcinosarcoma was conducted retrospectively from 2005 to 2012in our institution.All the patients were presented with painless gross hematuria as starting symptoms.Two of them also suffered from dysuria,and one of them also experienced urinary frequency and urgency.Through cystoscopy examination,tumors of two cases were located in lateral wall of bladder and that of one case was lacated in dome and bottom of bladder.All the patients accepted surgery treatment：one TURBT,one radical cystectomy and ileal conduit,and one radical cystectomy and bilateral cutaneous ureterostomy.Result：Postoperative pathology confirmed that all the tumors of three cases were high-grade carcinosarcoma.The patients were followed up for 10-36 months.Two patients died of multiorgan metastasis in ten months and two years after surgery respectively.The other one was still alive after three years of follow-up period.Conclusion：Carcinosarcoma of the bladder is a kind of rare malignant tumor with poor prognosis.Also,it isn＇t sensitive to chemotherapy and radiotherapy.Radical cystectomy appears to be the primary treatment.