膀胱憩室癌临床分析(附五例报告)

Carcinoma in bladder diverticulum (report of 5 cases)

目的 探讨膀胱憩室癌的临床病理特点和诊治方法。 方法 膀胱憩室癌 5例。男 4例 ,女 1例 ;平均年龄 73岁。术前膀胱镜下活检确诊 3例 ,术中冰冻切片确诊 2例。其中移行细胞癌2例 ,行膀胱部分切除术 ;鳞状细胞癌、腺癌和混合性癌 (鳞状细胞癌和移行细胞癌 )各 1例 ,均行根治性膀胱全切加回肠膀胱术。术后辅以化疗 3例 ,化疗加放疗 1例。 结果 5例随访 6～ 72个月 ,平均 2 3个月。 2例移行细胞癌分别于术后 6、8个月局部复发 ,行根治性膀胱全切加回肠膀胱术 ,术后 1例死于肿瘤转移 ,1例随访 6年无瘤存活。鳞癌者术后 14个月死于多器官转移。腺癌者术后 11个月死于心肌梗死。混合性癌者目前术后 6个月无瘤存活。 结论 膀胱憩室癌的诊断以膀胱镜和影像学检查为主 ,治疗应采取外科手术特别是根治性膀胱全切术 ,必要时辅以放、化疗。

Objective To explore the clinical and pathological features of carcinoma in bladder diverticulum,and its diagnosis and treatment. Methods This series included 5 cases of carcinomas in bladder diverticula (male,4 and female 1;mean age,73 years).Three cases were pre-operatively confirmed by biopsy with cystoscopy,and 2 were intra-operatively confirmed by frozen section of samples.Of the 5 cases,2 of transitional cell carcinoma underwent partial cystectomy;the remaining 3,each of whom had squamous cell carcinoma,adenocarcinoma and mixed carcinoma (squamous cell carcinoma and transitional cell carcinoma),underwent radical cystectomy and ileal neobladder.After operation 3 cases received chemotherapy,1 case received chemotherapy and radiotherapy. Results The 5 cases were followed up for an average of 23 months (6～72 months).Two cases of transitional cell carcinoma had relapse,and then underwent radical cystectomy and ileal neobladder.Of them 1 died of distant metastasis soon after operation,the other had survived free of tumor for 6 years since operation.The case of squamous cell carcinoma died of multiorgan metastasis 14 months after operation.The case of adenocarcinoma died of myocardial infarction 11 months after operation.The case of mixed carcinoma had survived free of tumor for 6 months since operation. Conclusions Cystoscopy and imaging play an important role in detecting tumors originating from the bladder diverticulum.Surgical operation,especially radical cystectomy,should be performed.Adjunctive therapies such as chemotherapy and radiotherapy can be conducted if necessary.