Stöckle M, Jacobi G H, Hohenfellner R
Urologische Klinik und Poliklinik, Johannes Gutenberg-Universität, Mainz, RFA.
J Urol (Paris). 1988;94(8):401-4.
Between 1967 and 1985, 246 cystectomies were performed for the treatment of urothelial carcinoma of the bladder. Surgery-related mortality, initially 15%, was equal to 0% in 1985. Preoperative radiation therapy was not given. Despite strictly comparable T and N stages, prognosis was markedly better in patients who had undergone cystectomy as soon as the diagnosis of invasive cancer of the bladder was established than in patients who had undergone cystectomy after one or more recurrences of invasive carcinoma of the bladder and after transurethral resection. Twenty-six patients, undergoing cystectomy because of recurrence after curative radiation therapy, were the group with the worst 5--years survival--less than 10%. These results allow us to conclude that for the prognosis of carcinoma after total cystectomy, it is of the utmost importance to differentiate between an initially invasive tumor and a recurrence of an invasive carcinoma after transurethral resection. If performed immediately after infiltration has been demonstrated, cystectomy may greatly contribute to improving the long-term prognosis. As soon as the tumor extends to the lamina propria (pT1), one can no longer expect transurethral electroresection to suffice as reliable curative treatment of carcinoma of the bladder. As for the argument that the procedure is mutilating, one can counter with the increasing success in the last few years, of urinary derivation with continence, including bladder replacement or even total cystoprostatectomy, which does not result in impotence.
1967年至1985年间，共进行了246例膀胱切除术以治疗膀胱尿路上皮癌。手术相关死亡率最初为15%，到1985年降至0%。未进行术前放疗。尽管T和N分期严格可比，但与在膀胱浸润性癌一次或多次复发后以及经尿道切除术后才进行膀胱切除术的患者相比，在确诊膀胱浸润性癌后立即进行膀胱切除术的患者预后明显更好。26例因根治性放疗后复发而接受膀胱切除术的患者，是5年生存率最差的一组，低于10%。这些结果使我们得出结论，对于全膀胱切除术后癌症的预后，区分最初的浸润性肿瘤和经尿道切除术后浸润性癌的复发至关重要。如果在证实浸润后立即进行膀胱切除术，可能会极大地有助于改善长期预后。一旦肿瘤侵犯至固有层（pT1），就不能再期望经尿道电切术足以作为膀胱肿瘤可靠的根治性治疗方法。至于认为该手术致残的观点，近年来尿流改道并保持控尿取得了越来越大的成功，包括膀胱替代甚至全膀胱前列腺切除术，这些手术不会导致阳痿，可予以反驳。
