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目的:探讨肌层浸润性膀胱癌(muscle invasive bladder cancer,MIBC)行保留膀胱手术治疗的可行性及临床价值。方法:回顾性分析43例MIBC患者的临床资料:男28例,女15例,年龄45～88岁,平均62岁。其中38例(88.4%)行经尿道膀胱肿瘤电切除术(transurethral resection of bladder tumor,TURBT),5例(11.6%)行膀胱部分切除术;术后均行膀胱灌注化疗或放疗。结果:术后病理分期:T236例(83.7%),T37例(16.3%);病理分级:G14例(9.3%),G231例(72.1%),G38例(18.6%)。术后随访6～126个月,平均63.2个月;首次复发为3～20周,平均10.2周,复发次数1～8次,平均3.7次;共行2～9次TURBT,平均3.5次,其中25例(58.1%)于≥3次TURBT后出现病理性进展,9例(20.9%)于术后复发次数≥3次后改行根治术;2例(4.7%)死于非膀胱癌疾病,1例(2.3%,病理为T2G1)于首次术后126个月死于膀胱癌多发转移。结论:对于MIBC,可选择性行以TURBT为主加放化疗的保留膀胱手术治疗,但具有反复复发及进展倾向;首次复查膀胱镜时间需提前到术后4～8周,远期疗效需进一步评估。
Objective: To investigate the feasibility and clinical value of preserving bladder surgery in patients with muscle invasive bladder cancer (MIBC). Methods: A retrospective analysis of 43 cases of MIBC patients clinical data: 28 males and 15 females, aged 45 to 88 years, mean 62 years. Thirty-eight patients (88.4%) underwent transurethral resection of bladder tumor (TURBT) and 5 patients (11.6%) underwent partial bladder resection. All patients received intravesical chemotherapy or radiotherapy after operation. Results: The postoperative pathological staging was T236 (83.7%) and T37 (16.3%). The pathological grade was G14 (9.3%), G231 (72.1%) and G38 (18.6%). The patients were followed up for 6 to 126 months with an average of 63.2 months. The first recurrence was from 3 to 20 weeks, with an average of 10.2 weeks. The recurrences ranged from 1 to 8 times (average, 3.7 times). TURBT was performed for 2 to 9 times on an average of 3.5 times Pathological changes occurred in 25 cases (58.1%) after ≥3 TURBT, and in 9 (20.9%) cases, radical resection was performed after more than 3 times of recurrence. Two cases (4.7%) died of non-bladder cancer, Cases (2.3%, pathological T2G1) died of multiple bladder cancer metastasis at 126 months after the first operation. Conclusions: For MIBC, TURBT-based chemotherapy plus bladder preserving surgery may be selected, but recurrence and propensity to recurrent tend to occur. Cystoscopy should be performed 4 to 8 weeks after the initial review, and the long-term efficacy needs further Evaluation.