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目的总结探讨肌层浸润性膀胱癌患者保留膀胱手术治疗的可行性。方法选择2008年6月至2010年2月周口市中医院收治的78例肌层浸润性膀胱癌患者为研究对象,根据术式差异分为保留膀胱手术组38例、膀胱切除根治手术组40例(根治组),以Kaplan-Meier方法计算两组患者术后1、2、3、5年的生存率。结果保留组术后1、2、3、5年的生存率分别为97.37%、92.11%、73.68%、47.37%,其保留膀胱生存期为(47.52±2.8)个月。放化疗期间17例因血液毒性导致白细胞不足30×109/L,5例出现膀胱炎,但膀胱功能良好。随访期内复发18例(47.37%)。根治组术后1、2、3、5年的生存率分别为97.50%、95.00%、72.50%、47.50%,术后并发症发生率为65.00%。随访期间8例远处转移,7例盆腔复发。两组患者术后各阶段生存率相近,差异未见统计学意义(P>0.05)。结论保留膀胱手术治疗肌层浸润性膀胱癌可以达到与根治术相似的临床疗效,两种术式的生存率相近,保留膀胱手术是可行的。
Objective To summarize the feasibility of preserving bladder surgery in patients with muscle invasive bladder cancer. Methods Seventy eight patients with myometrial invasive bladder cancer who were treated in Zhoukou Hospital of Traditional Chinese Medicine from June 2008 to February 2010 were selected as study subjects. According to the surgical procedures, 38 cases were treated with bladder surgery, 40 cases with radical resection of the bladder (Radical group). The Kaplan-Meier method was used to calculate the 1, 2, 3, 5-year survival rates of the two groups. Results The survival rates at 1, 2, 3 and 5 years after operation in the retention group were 97.37%, 92.11%, 73.68% and 47.37%, respectively. The survival time of the bladder in the retention group was (47.52 ± 2.8) months. Chemotherapy during 17 cases due to hematologic toxicity caused by leukocytes less than 30 × 109 / L, 5 cases of cystitis, but the bladder function well. During the follow-up period, 18 cases (47.37%) relapsed. The survival rates at 1, 2, 3 and 5 years in the radical group were 97.50%, 95.00%, 72.50% and 47.50% respectively, and the postoperative complication rate was 65.00%. During the follow-up period, 8 cases were distantly metastasized and 7 cases had pelvic recurrence. There was no significant difference between the two groups in postoperative survival rates (P> 0.05). Conclusion Retained bladder surgery for myometrial invasive bladder cancer can achieve similar clinical efficacy and radical operation, the survival rate of the two procedures are similar, the retention of bladder surgery is feasible.