摘要
目的:探讨维持血液透析患者并发膀胱肿瘤的病理、临床特点及预后。方法:对21例长期规律血液透析并发膀胱肿瘤患者的临床资料进行回顾性分析。结果:发病时平均血液透析时间为43个月,多数患者表现为间歇无痛肉眼血尿或尿道排出血性分泌物。13例为多病灶发病,8例为单病灶。17例行经尿道膀胱肿瘤电切术,3例行膀胱部分切除术。1例行腹腔镜一期全泌尿系器官切除术。术后病理显示:非肌层浸润性肿瘤12例,肌层浸润性肿瘤9例。分级:G14例,G27例,G310例。平均随访(31±14.5)个月,膀胱肿瘤复发11例,继发上尿路肿瘤6例,死于肿瘤转移者7例,非肿瘤死亡者3例。1年、2年、3年肿瘤特异生存率分别为85%、56%、37%。结论:长期维持血液透析患者并发膀胱肿瘤具有分化较差、恶性度高的生物学特点,容易复发和转移。早期发现和恰当的治疗方案对于改善预后有十分重要的意义。
Objective： To investigate the clinical characteristics and outcomes of patients on hemodialysis who were diagnosed with urothelial carcinoma of the bladder. Method： The medical records of 21 patients on mainte nance hemodialysis with urothelial carcinoma of the bladder were retrospectively reviewed from Jan 2004 to Jan 2012. Clinical, pathological and treatment related data were analyzed retrospectively. Result： Mean hemodialysis duration before the identification of bladder cancer was 43 months. Painless gross hematuria or urethral bloody discharge were the most common complaints. Of all the patients, 17 cases had undergone transurethral resection, three cases had undergone partial cystecctomy and one patient was treated with one step laparoscopic total exentera tion of the urinary tract. The final pathological study demonstrated that 12 patients had non-muscle invasive bladder cancer and nine patients had muscle invasive bladder cancer, 10 cases had high grade tumors. At a median follow up of （31± 14.5） months, 11 patients experienced bladder tumor recurrence and six patients had secondary upper urinary tract transitional cell carcinoma, seven patients died of tumor-related factors and three patients died of non-tumor diseases. The tumor special survival rate was 85%, 56%, 37% at one, two, three years respective ly. Conclusion： The biological behavior of the bladder cancer in patients on maintenance hemodialysis is commonly aggressive and the prognosis is generally poor. Early detection and appropriate treatment play an important role for better long-term outcome.
出处
《临床泌尿外科杂志》
2013年第9期648-651,共4页
Journal of Clinical Urology
