Ricós Torrent J V, Solsona Narbon E
Servicio de Urología, Instituto Valenciano de Oncología (I.V.O.), Valencia, España.
Arch Esp Urol. 1999 Jul-Aug;52(6):577-85.
To analyze the results and indications of the three surgical techniques commonly utilized alone or as part of other treatments for infiltrating bladder tumors.
Our series of patients with infiltrating bladder tumors are analyzed and the literature reviewed.
Transurethral resection (TUR) is essential for tumor staging and is controversial as a therapeutic approach. However, using stringent selection criteria and careful follow-up, retrospective studies have reported survival rates of 82-83%, which are similar to those of radical cystectomy in similar cases, but with bladder preservation rates of 67%-75%. However, only 19-21% of patients can benefit from this surgical technique and the selection criteria are relatively subjective. Partial cystectomy achieves a considerable survival rate of 40-80%, but very stringent selection criteria must be met, which are partly similar to those of the previously mentioned technique, therefore it is not an alternative to TUR since it is a more aggressive surgical procedure. It could be an alternative to radical cystectomy in the more advanced stages of the disease, but although it may be technically biologically feasible, there is a high risk of local and cicatricial recurrence and difficulty in the early detection of recurrence caused by the anatomical disturbance in the bladder wall. For all the foregoing, partial cystectomy is utilized only for very specific cases of urachal carcinoma, as a palliative approach instead of cystectomy, or for areas that are not accessible to TUR. However, although it has specific indications, it has been demonstrated to be effective in the evaluation of the response to chemotherapy and systematically utilized in bladder preservation programs.
Radical cystectomy continues to be the standard treatment for infiltrating bladder tumors with overall 5-year survival rates in recent series ranging from 56%-72%, and is related with the pathological stage and particularly nodal involvement. The morbidity has dropped and the operative mortality rate is about 2%. Quality of life has also improved with the new techniques of urinary diversion, especially orthotopic diversion.
分析三种常用于浸润性膀胱肿瘤单独治疗或作为其他治疗一部分的手术技术的结果和适应证。
对我们的浸润性膀胱肿瘤患者系列进行分析并复习文献。
经尿道切除术（TUR）对肿瘤分期至关重要，作为一种治疗方法存在争议。然而，采用严格的选择标准并进行仔细随访，回顾性研究报告生存率为82% - 83%，与类似病例中根治性膀胱切除术的生存率相似，但膀胱保留率为67% - 75%。然而，只有19% - 21%的患者能从该手术技术中获益，且选择标准相对主观。部分膀胱切除术的生存率可达40% - 80%，但必须满足非常严格的选择标准，部分与前述技术的标准相似，因此它不是TUR的替代方法，因为它是一种更激进的手术。在疾病的更晚期，它可能是根治性膀胱切除术的替代方法，但尽管在技术生物学上可能可行，局部和瘢痕复发风险高，且由于膀胱壁解剖结构紊乱，早期复发检测困难。基于上述所有原因，部分膀胱切除术仅用于脐尿管癌的非常特殊的病例，作为姑息性方法替代膀胱切除术，或用于TUR无法到达的区域。然而，尽管它有特定适应证，但已证明其在评估化疗反应方面有效，并在膀胱保留计划中得到系统应用。
根治性膀胱切除术仍然是浸润性膀胱肿瘤的标准治疗方法，近期系列研究中总体5年生存率为56% - 72%，且与病理分期特别是淋巴结受累有关。发病率有所下降，手术死亡率约为2%。随着尿流改道新技术的出现，尤其是原位改道，生活质量也有所提高。
