Darenkov S P, Gorilovskiĭ M L, Chernyshev I V, Akmatov N A
Urologiia. 2003 Sep-Oct(5):5-8.
Our aim was to determine indications for urethrectomy in patients with muscle-invasive cancer of the urinary bladder (UBC) which is essential for choice of urine derivation. A total of 51 patients with invasive UBC at the age of 33-78 years (mean age 60 years) were treated: 7 patients with pT2bN0M0, 1 patient with pT2bN1M0, 18 patients with pT3aN0M0, 3 patients with pT3aN1M0, 14 patients with pT3bN0M0, 6 patients with pT4aN0M0, 2 patients with pT4bN0M0. Urethrectomy was indicated for men with involvement of the prostatic urethra (stage t4a) and urinary bladder cervix, multiple tumors of the bladder, pelvic lymph node lesions, detection of tumor cells by instant biopsy in the free urethral edge, poor differentiation of the tumor (G3) in combination with one of the above factors, emergence of urethrorrhagia late after cystectomy; for women with involvement of the bladder cervix and Lieutaud's triangle in combination with poor differentiation of the tumor cells (G3). Cystectomy was followed by urine derivation of the following type: uretero-ureteroanastomosis with nephrostomy (n = 2), ureterocutaneostomy (n = 3), Briker's operation (n = 22), ureterosygmoanastomosis with creation of sigmoid reservoir (method Mainz pouch II) (n = 21), Studer orthotopic plastic reconstruction (n = 2) and Hautmann plastic surgery (n = 1). Urethrectomy was made in 16 patients. One-stage operation was conducted in 14 patients (suprapubic approach--8 males, perineal one--in 6 females). Delayed urethrectomy was made in 2 patients. Intra- and postoperative complications caused by urethral removal were absent. Corrected 2-year survival for all 51 patients was 70.8 +/- 11.3%. Among the deceased were 2 patients who had undergone urethrectomy at the stage T2b and T4a 5 and 8 months after primary operation, respectively. Thus, we believe that urethrectomy must be made in the above indications and poor differentiation of the tumor cells (G3).
我们的目的是确定膀胱肌肉浸润性癌（UBC）患者行尿道切除术的指征，这对于尿液改道方式的选择至关重要。共治疗了51例年龄在33 - 78岁（平均年龄60岁）的浸润性UBC患者：7例为pT2bN0M0，1例为pT2bN1M0，18例为pT3aN0M0，3例为pT3aN1M0，14例为pT3bN0M0，6例为pT4aN0M0，2例为pT4bN0M0。对于前列腺尿道受累（t4a期）、膀胱宫颈受累的男性患者，以及膀胱多发肿瘤、盆腔淋巴结病变、尿道游离缘即时活检发现肿瘤细胞、肿瘤低分化（G3）合并上述因素之一、膀胱切除术后晚期出现尿道出血的患者，建议行尿道切除术；对于膀胱宫颈和列奥塔三角受累且肿瘤细胞低分化（G3）的女性患者，建议行尿道切除术。膀胱切除术后采用以下类型的尿液改道：输尿管 - 输尿管吻合术加肾造瘘术（n = 2）、输尿管皮肤造口术（n = 3）、布里克尔手术（n = 22）、输尿管乙状结肠吻合术并创建乙状结肠贮尿囊（美因茨Ⅱ型术式）（n = 21）、施图德原位整形重建术（n = 2）和豪特曼整形手术（n = 1）。16例患者行尿道切除术。14例患者进行一期手术（耻骨上入路——8例男性，经会阴入路——6例女性）。2例患者行延迟尿道切除术。未出现因尿道切除导致的术中及术后并发症。51例患者校正后的2年生存率为70.8%±11.3%。死亡患者中有2例分别在初次手术后5个月和8个月时处于T2b期和T4a期接受了尿道切除术。因此，我们认为在上述指征及肿瘤细胞低分化（G3）的情况下必须行尿道切除术。
