肌层浸润性膀胱癌保留膀胱综合治疗的疗效分析

Analysis of the efficacy of preserved bladder therapy for sarcomtrial invasive bladder carcinoma

目的观察分析肌层浸润性膀胱癌(MIBC)保留膀胱综合治疗(CBST)的疗效。方法回顾性分析2009年1月~2013年12月期间在我院泌尿外科行膀胱癌手术治疗的患者,根据手术方式分为两组,对照组给予膀胱根治性切除(RC)+尿流改道,观察组给予保留膀胱的综合治疗。对比分析两组的总生存期(OS),无进展生存期(PFS),生活质量在功能领域、总体生命质量领域、症状领域、单一条目领域的评分。结果CBST组及对照组在平均随访时间、OS及PFS两两比较均无明显差异(P>0.05),CBST组患者术后在功能领域及总体生命质量领域明显优于对照组(P<0.01),两组比较有明显差别;两组患者在症状领域及单一条目领域总体表现无差异(P>0.05)。结论①CBST模式在保留膀胱功能的前提下可以根除肿瘤;②CBST模式与根治性膀胱切除相比并未减少术后生存时间;③CBST术后可获得更好的功能状况;④CBST术后总体生命质量更优;⑤对于排斥RC或合并RC手术禁忌的MIBC病例,在谨慎评估后CBST模式可以作为RC的替代治疗方案;⑥无论RC还是CBST,积极的精神心理疏导可能会提高患者术后的生活质量。

Objective To study the efficacy analysis of comprehensive of bladder-sparing treatment(CBST).Methods Patients undergoing bladder cancer surgery in our urological surgery from January 2009 to December 2013 were divided into two groups:the control group and the CBST group.The control group received radical cystectomy(RC)+urinary flow diversion,and the observation group received comprehensive treatment with reserved bladder.The OS,PFS,and the QOL scores in the functional domain,overall QoL domain,symptom domain,single entry field between the two groups were compared.Results There was no significant difference in CBST,OS and PFS(P>0.05),and the field of functional field and overall quality of life in the CBST group were significantly better than those in the control group(P<0.01),with significant difference between the two groups;There was no difference between the two groups in the symptom field or single item field(P>0.05).Conclusion①CBST mode could eradicate the tumor while preserving bladder function;②The CBST pattern did not reduce the postoperative survival time compared with radical cystectomy;③Better functional status can be achieved after CBST;④Overall quality of life was better after CBST;⑤The CBST pattern can be used as an alternative treatment option for RC after careful evaluation for MIBC cases;⑥Regardless of RC or CBST,positive psychosocial counseling may improve life after surgery.