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[根治性治疗后肌肉浸润性膀胱癌的随访监测]

[Follow-up surveillance of muscle-invasive urinary bladder cancer after curative treatment].

作者信息

Schulz G B, Stief C G, Schlenker B

机构信息

Urologische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität (LMU) München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.

出版信息

Urologe A. 2019 Sep;58(9):1093-1106. doi: 10.1007/s00120-019-1012-4.

Abstract

Follow-up care of patients with muscle-invasive bladder cancer is subdivided into oncological and functional surveillance. More than 80% of local relapses and distant metastases occur within the first 2 years. Recurrences in the remnant urothelium also occur several years after radical cystectomy. Urinary cytology and a computed tomography (CT) scan of the abdomen and thorax including a urography phase are the standard diagnostics for tumor follow-up. There is no clear evidence for a survival benefit for the detection of asymptomatic vs. symptomatic recurrences. After partial cystectomy or trimodal treatment, there is no established follow-up schedule; however, the relatively high incidence of intravesical recurrences should be considered as there are curative treatment approaches including salvage cystectomy. Functional surveillance, which should be carried out lifelong, encompasses prevention and diagnostics of metabolic complications, urethral/ureteral strictures, problems with the urinary stoma, urinary incontinence, sexual dysfunction and urinary tract infections.

摘要

肌层浸润性膀胱癌患者的随访可细分为肿瘤学监测和功能监测。超过80%的局部复发和远处转移发生在头2年内。根治性膀胱切除术后数年,残余尿路上皮也会出现复发。尿细胞学检查以及包括尿路造影期在内的腹部和胸部计算机断层扫描(CT)是肿瘤随访的标准诊断方法。对于无症状复发与有症状复发的检测,尚无明确证据表明其对生存有益。在膀胱部分切除术或三联治疗后,尚无既定的随访方案;然而,应考虑膀胱内复发的相对高发生率,因为存在包括挽救性膀胱切除术在内的治愈性治疗方法。功能监测应终身进行,包括代谢并发症、尿道/输尿管狭窄、尿造口问题、尿失禁、性功能障碍和尿路感染的预防与诊断。

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