膀胱癌术后腹壁切口种植转移的治疗与预后

Implantation metastasis to abdominal incision after open operation for bladder carcinoma

目的 总结膀胱部分切除术后腹壁切口种植转移患者的诊治效果。 方法 1985～1999年共收治膀胱癌术后腹壁切口种植转移患者 10例。男 9例 ,女 1例。年龄 39～ 6 8岁。移行细胞癌 6例 ,均为低分化G3 肿瘤 ;移行细胞癌合并鳞癌和腺癌各 1例 ,鳞癌和粘液腺癌各 1例。腹壁转移灶 1.0～ 6 .9cm× 1.4～ 11.5cm。 结果 采用膀胱全切加腹壁转移灶切除 2例 ,经尿道膀胱肿瘤电切术 (TURBT)加腹壁转移灶切除 1例 ,尿流改道加放疗和 (或 )化疗 2例 ,腹壁转移灶切除加放疗和 (或 )化疗 3例 ,单纯放疗和 (或 )化疗 2例。 10例中死亡 7例 ,其中 6例生存 4～ 14个月 ,1例生存4 1个月 ;3例存活者随访 5～ 9个月 ,未见复发。 结论 膀胱癌术后腹壁切口种植转移癌一般分化差 ,或合并其他癌。膀胱全切加肿物切除 ,辅助放化疗虽然能延长患者生存期 。

Objective To study the diagnosis, treatment, and prognosis of implantation metastasis to abdominal incision after open operation for bladder carcinoma. Methods 10 cases of implantation metastasis to abdominal incision after open operation for bladder carcinoma encountered from 1985 to 1999 were retrospectively studied,nine being male and 1 female.The average age was 52.7 years. Results These were 6 transitional cell carcinoma (all were grade G 3),2 transitional cell carcinoma with squamous carcinoma or adenocarcinoma,1 squamous carcinoma,and 1 adenocarcinoma.The diameter of the metastasis lesion was 1.4～11.5 cm×1.0～6.9 cm.The treatments included total cystectomy with resection of metastasis,TURBt with resection of metastasis,urinary diversion with chemotherapy and/or radiotherapy, resection of metastasis with chemotherapy and/or radiotherapy, and chemotherapy and/or radiotherapy alone.7 of the 10 died of the carcinoma,the survival times being 4～41 months (average 13 months).Only 1 patient survived for 41 months.Whereas the others died within 14 months.3 patients are still alive for 5～9 months with no recurrence. Conclusions The differentiation of the cancer cells of implantation metastasis is usually bad and often accompanied by squamous followed by carcinoma or adenocarcinoma.Total cystectomy with resection of the metastasis followed by chemotherapy and/or radiotherapy might prolong the survival time, but the prognosis is usually poor.