T2期膀胱尿路上皮癌膀胱部分切除术和根治性膀胱切除术的比较分析

目的分析T2期膀胱尿路上皮癌膀胱部分切除术和根治性膀胱切除术对生存率的影响。方法对行膀胱部分切除术和根治性膀胱切除术的初发T2期膀胱尿路上皮癌患者的临床资料及随访结果进行回顾性研究。结果膀胱部分切除术168例，其中T2a期103例，T2b期65例，术后均行膀胱灌注化疗。根治性膀胱切除术70例，其中T2a期34例，T2b期36例，术后盆腔淋巴结阳性者行辅助化疗。随访2～18年，膀胱部分切除术后复发135例，肿瘤转移102例，死亡108例，3年、5年、10年生存率分别为77．6％、51．8％、32．4％。根治性膀胱切除术后肿瘤转移19例，死亡28例，3年、5年、10年生存率分别为82．6％、73．7％、57．0％。根治性膀胱切除术后3年生存率与膀胱部分切除术相近（P〉0．05），但5年、10年生存率明显高于膀胱部分切除术（均P〈0．05）。结论T2期膀胱尿路上皮癌的生存率与首次手术方式有关，术后长期生存率根治性膀胱切除术好于膀胱部分切除术。

Comparative analysis between partial cystectomy and radical cystectomy of T2 urotheliai bladder carcinoma

Objective To study T2 urothelial bladder carcinoma patients underwent radical eystectomy and partial cystectomy,then find the influence of two operation manners on survival rate. Methods The clinical data,histopathological reports and follow-up results of T2 urothelial bladder carcinoma patients underwent radical cystectomy and partial cystectomy were studied retrospectively. Results From 1991 to 2006, 168 patients（70. 6%）were underwent partial cystectomy . Of this group 103 patients had Tea （superficial） and 65 had T2b （deep） muscle invasive tumors. After partial cysteetomy,alt patients were underwent intravesical chemotherapy. 70 patients （29.4%） were underwent radical cysteetomy. Of this group 34 patients had T2a （superficial） and 36 had T2b （deep） muscle invasive tumors. After radical cystectomy,patients with pelvic node positive were underwent adjuvant chemotherapy. At follow-up of 2-18 years, 135 patients occurred recurrence, 102 patients had distant metastatic disease,and 108 patients died after partial cystectomy. 19 patients had distant metastatic disease,and 28 patients died after radical cystectomy. No significant difference was observed in 3-year survival rate between patients underwent radial cysteetomy and patients underwent partial cysteetomy （82.6% vs 77.6% ,P〉0.05） ,but difference was observed in 5-year survival rate and 10-year survival rate between the two groups （73.7G vs 51.8G ,P（0.05;57.0% vs 32.4%,P〈0.05）. Conclusions the first operation manner has influence on the survival rate of T2 urothelial bladder eareinoma patients, patients underwent radical eysteetomy have better long survival rate than patients underwent partial eystectomy.