CAJ | 학술논문

目的探讨膀胱憩室癌的临床特征和诊疗方法,以期提高其诊疗水平.方法膀胱憩室癌患者13例,男11例,女2例;年龄59～86岁,平均年龄为(69.2±4.1)岁.13例患者均行膀胱B超、静脉尿路造影(IVU)、CT和膀胱镜检查,CT检查均发现膀胱憩室和憩室腔内软组织块.均行手术治疗,2例憩室内巨大肿瘤行根治性膀胱全切回肠膀胱术;膀胱部分切除术4例,其中1例行右侧输尿管膀胱移植术;切除膀胱憩室7例.术后,腺癌者仅予化疗.混合性癌者辅以放疗加化疗.结果术后随访8～72个月,平均随访时间为(22.2±3.1)个月.4例移行细胞癌患者于术后6～10个月局部复发,行根治性膀胱切除加回肠膀胱术,术后1例死于肿瘤转移;另4例移行细胞癌患者随访6年无瘤存在.1例鳞癌患者术后18个月死于多脏器转移.1例腺癌患者术后13个月死于急性心肌梗死;另2例腺癌患者随访6年无瘤存在.1例混合性癌患者术后10个月无瘤存活.结论 CT和膀胱镜检查是确诊膀胱憩室癌的重要方法,膀胱憩窜癌的数目及大小、部位和形态诊断主要依靠膀胱镜和影像学检查.治疗应采取外科手术,对癌症广泛转移者应以根治性切除为主.
목적 탐토방광게실암적림상특정화진료방법,이기제고기진료수평.방법 방광게실암환자13례,남11례,녀2례;년령59～86세,평균년령위(69.2±4.1)세.13례환자균행방광B초、정맥뇨로조영(IVU)、CT화방광경검사,CT검사균발현방광게실화게실강내연조직괴.균행수술치료,2례게실내거대종류행근치성방광전절회장방광술;방광부분절제술4례,기중1례행우측수뇨관방광이식술;절제방광게실7례.술후,선암자부여화료.혼합성암자보이방료가화료.결과 술후수방8～72개월,평균수방시간위(22.2±3.1)개월.4례이행세포암환자우술후6～10개월국부복발,행근치성방광절제가회장방광술,술후1례사우종류전이;령4례이행세포암환자수방6년무류존재.1례린암환자술후18개월사우다장기전이.1례선암환자술후13개월사우급성심기경사;령2례선암환자수방6년무류존재.1례혼합성암환자술후10개월무류존활.결론 CT화방광경검사시학진방광게실암적중요방법,방광게찬암적수목급대소、부위화형태진단주요의고방광경화영상학검사.치료응채취외과수술,대암증엄범전이자응이근치성절제위주.
Objective To evaluate the clinical characteristics, treatment and diagnosis of carcinoma in diverticula. Methods Thirteen patients with carcinoma in diverticula, including 11 males and 2 females, with a mean age of (69.2±4.1) years old (ranging 59-86), were included in the present study. All patients were examined by bladder type-B ultrasonic, intravenous urography (IVU), CT and cystoscopy. CT examination revealed soft tissue masses in the diverticula or diverticula cavity. The masses were all treated by operation. Two cases underwent radical cystectomy and ileal neobladder, 4 patients underwent partial cystectomy, including one receiving ureter bladder transplantation. Seven patients had their diverticula resected. After operation, patients with adenocarcinoma received chemotherapy; and cases of mixed carcinoma received both chemotherapy and radiotherapy. Results The patients were followed up for an average of 22 months (8-72 months) after operation. Four patients with transitional cell carcinoma had relapse during 6-10 months after operation; they were then subjected to radical cystectomy and ileal neobladder, and one of them died of distant metastasis soon after operation. The other four patients with transitional cell carcinoma survived free of tumor during 6 years follow-up. One patient with squamous cell carcinoma died of multi-organ metastasis 18 months after operation. One patient with adenocarcinoma died of acute myocardial infarction 13 months after operation; the other 2 patients with adenocarcimoma survived free of tumor during 6 years of follow-up. The patient with mixed carcinoma have survived free of tumor for 10 months since operation. Conclusion TC and cystoscopy are important examinations to confirm carcinoma in diverticula. Diagnosis of tumor numbers, sizes, location and morphology mainly depend on imaging diagnosis and cystoscopy. Surgical treatment should be used for treatment, and radical resection should be performed for those with extensive metastasis.