摘要
肌层浸润性膀胱癌(MIBC)治疗的经典方案为根治性全膀胱切除+盆腔淋巴结清扫术,但近些年来国内外研究报道对MIBC患者采用保留膀胱手术+综合治疗,可获得相似或超过RC之疗效。分析保留膀胱手术可取得较好疗效与MIBC患者之相对分期低、病理分级属低级别性质肿瘤以及采用新辅助、辅助化、放疗等综合治疗密切相关。MIBC包括3个分期(T2、T3、T4),如能对不同分期制定相应的个体化治疗方案,而不是一律采用RC,相信会避免过度治疗且会进而提高MIBC患者生存率和生活质量。为此本文提出对MIBC中不同分期患者采用个体化综合治疗方案的设想:T2a期采用TURBT或根治性TURBT+术后膀胱灌注化疗;对T3a期新辅助化疗1～2疗程后行PR+盆腔淋巴清扫术,术后膀胱灌注化疗+辅助性化、放疗等综合治疗。余不同分期方案见文内。以上方案之设想仅供研讨,期盼进一步完善,提高疗效。
The traditional surgery for muscle invasive bladder cancer （MIBC） is radical eystectomy plus pelvic lymphadenectomy, however, recently some studies have shown that bladder preservation multimodality therapy can be an alternative to radical cystectomy for treatment of MIBC. We believed that compared to the radical cystectomy, some M1BC patients get the better prognosis and keep the functional bladder were clue to the low stage, low grade of the cancer and they received the multimodality therapy. MIBC can be divided into three stages （T2, T3 and T1 ）, therefore the treatment for these three stage should be different, all these three stages received the same radical cystectomy were not reasonable. In this article, we supposed that the MIBC patients of different stages should received individual comprehensive therapy, for example： for MIBC patients of Te2a, they should receive radical transurethral resection of bladder tumor （TURBT） plus intravesical chemotherapy; for patients of T3a, stage, they should receive neoadjuvant chemotherapy first, then partial cystectomy plus pelvic lymphadenectomy, then intravesical chemotherapy and adjuvant chemotherapy or adjuvant radiotherapy. Some studies support our opinion, and we will talk it into detail in this paper.
出处
《临床泌尿外科杂志》
2013年第5期321-324,共4页
Journal of Clinical Urology
