膀胱癌诊疗的研究进展

Research Progress in the Diagnosis and Treatment of Bladder Cancer

膀胱癌是泌尿系统最常见的恶性肿瘤,超声筛查是常见的诊断方法,膀胱镜检查是金标准,确定临床分期依靠计算机扫描尿路造影(CTU)和病理。非肌层浸润性膀胱癌的治疗以经尿道膀胱肿瘤切除为主,部分肌层浸润性膀胱癌的治疗通过经尿道膀胱肿瘤切除或膀胱部分切除,术后结合新辅助化疗实现保留膀胱功能,可以取得与膀胱全切术相近的肿瘤学预后。膀胱癌术后肿瘤复发和进展的风险主要与组织病理分期、分级相关。根治性膀胱切除联合盆腔淋巴结清扫是肌层浸润性膀胱癌的标准治疗术式,原位新膀胱术是一种可提供维持长期功能的优良尿流改道术式。输尿管皮肤造口仍是简单和安全的尿流改道术式。本文就膀胱癌诊断、筛查方法、手术指征、治疗方法及术后管理等诊疗进展进行综述。

Bladder cancer is the most common malignant tumor of the urinary system,ultrasound screening is a common diagnostic method,cystoscopy is the gold standard,the clinical staging depends on computed tomography urography (CTU) and pathology.Transurethral resection of bladder tumor is the main treatment for non-muscular invasive bladder cancer,and the treatment of partial muscular invasive bladder cancer is through trasnurethral resection of bladder tumor or patical cystectomy,combined with neoadjuvant chemotherapy to preserve bladder function after surgery to obtain an oncology prognosis similar to that of total cystectomy.The risk of tumor recurrence and progression after bladder cancer surgery is mainly related to histopathological staging and grading.Radical cystectomy combined with pelvic lymph nodes dissection is the standard treatment for muscular invasive bladder cancer.In situ bladder neovasystectomy is an excellent urinary diversion operation that can maintain long-term function.Ureterostomy is still a simple and safe urinary diversion operation.This article reviews the diagnosis and treatment progress of bladder cancer diagnosis,screening methods,surgical indication,treatment methods and postoperative management.