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目的探讨高龄(≥75岁)浸润性膀胱癌患者行全膀胱切除术的可行性及疗效。方法1995年1月至2003年1月收治高龄(≥75岁)浸润性膀胱癌行全膀胱切除术患者10例,均为男性,平均年龄76岁。从手术时间、术中输血、术后并发症、生存率等方面与同期40例浸润性膀胱癌(<75岁,对照组)行全膀胱切除术患者进行比较。结果高龄组平均手术时间360min,平均术中输血1500ml,平均术后住院时间20d,对照组分别为316min,1200ml,16d,两组比较差异无统计学意义(P>0.05)。高龄组和对照组术后近期并发症分别为6例(60%)、10例(25%),P<0.05。高龄组7例获随访,1、5年生存率分别为71.4%、57.1%。对照组40例获得随访,1、5年生存率分别为90.0%,65.0%。高龄组患者1年生存率明显低于对照组(P<0.05),而5年生存率比较差异无统计学意义(P>0.05)。结论全膀胱切除术可以安全地应用于适当选择的高龄患者,年龄不应成为高龄浸润性膀胱癌患者行根治性全膀胱切除术的排除标准。
Objective To investigate the feasibility and efficacy of total cystectomy in elderly (≥75 years) patients with invasive bladder cancer. Methods From January 1995 to January 2003, 10 patients undergoing total cystectomy for advanced bladder cancer (≥75 years old) were enrolled. All were male, with a mean age of 76 years. 40 patients with invasive bladder cancer (<75 years old, control group) underwent total cystectomy were compared in terms of operation time, intraoperative blood transfusion, postoperative complications and survival rate. Results The average operation time was 360 min in the advanced age group, the average intraoperative blood transfusion was 1500 ml and the average postoperative hospital stay was 20 days. The control group was 316 min, 1200 ml and 16 d respectively. There was no significant difference between the two groups (P> 0.05). There were 6 cases (60%) and 10 cases (25%) of postoperative complications in the elderly group and the control group respectively, P <0.05. In the advanced age group, 7 patients were followed up, and the 1- and 5-year survival rates were 71.4% and 57.1% respectively. Control group 40 cases were followed up, 1, 5-year survival rates were 90.0%, 65.0%. The 1-year survival rate of the elderly group was significantly lower than that of the control group (P <0.05), while the 5-year survival rate was no significant difference (P> 0.05). Conclusions Total cystectomy can safely be applied to properly selected elderly patients and age should not be an exclusionary criterion for radical cystectomy in patients with advanced invasive bladder cancer.