Talamonti M S, Shumate C R, Carlson G W, Curley S A
Department of General Surgery, University of Texas, M. D. Anderson Cancer Center, Houston.
Surg Gynecol Obstet. 1993 Nov;177(5):481-7.
We reviewed the records of 70 patients who underwent resection of a carcinoma of the colon and rectum with en bloc total cystectomy (36 patients) or partial cystectomy (34 patients) because of tumor directly extending into the urinary bladder. Preoperative genitourinary symptoms were present in 33 of the 70 patients (41.7 percent) and were highly predictive of malignant invasion of the bladder (97.0 percent). Duration of catheter drainage after partial cystectomy correlated with early postoperative bladder function; all 25 patients who had the catheter remain in place at least ten days had normal voiding after catheter removal, while five of nine patients whose catheter was removed before ten days had retention requiring catheter reinsertion (p < 0.01). Urologic complications occurred in two patients after total cystectomy and in three patients after partial cystectomy. There were three postoperative deaths in the total cystectomy group but none after partial cystectomy. Sixty-four patients with negative resection margins had a median survival period of 34 months and a five-year actuarial survival rate of 51.8 percent. In contrast, the median survival period for six patients who had positive margins was 11 months, with no survivors at five years.
我们回顾了70例因肿瘤直接侵犯膀胱而接受结肠直肠癌切除术并整块全膀胱切除术（36例）或部分膀胱切除术（34例）患者的记录。70例患者中有33例（41.7%）术前存在泌尿生殖系统症状，这些症状对膀胱恶性侵犯具有高度预测性（97.0%）。部分膀胱切除术后导尿管引流时间与术后早期膀胱功能相关；25例导尿管留置至少10天的患者在拔除导尿管后排尿正常，而9例导尿管在10天前拔除的患者中有5例出现尿潴留需要重新插入导尿管（p<0.01）。全膀胱切除术后有2例患者发生泌尿系统并发症，部分膀胱切除术后有3例患者发生泌尿系统并发症。全膀胱切除组有3例术后死亡，部分膀胱切除组无术后死亡。64例切缘阴性的患者中位生存期为34个月，5年精算生存率为51.8%。相比之下，6例切缘阳性患者的中位生存期为11个月，5年无幸存者。
