Cespedes R D, McGuire E J, Donat S M, Babaian R J
Department of Urology, University of Texas Medical School at Houston 77030, USA.
Semin Urol Oncol. 1996 May;14(2):103-11.
The patient with T3b transitional cell carcinoma (TCC) of the bladder has traditionally been treated with radical cystectomy and urinary diversion, but initial success with systemic chemotherapy and renewed interest in quality-of-life issues has increased interest in bladder preservation treatments. Unfortunately, despite multiple trials using limited surgical procedures and neoadjuvant or adjuvant chemotherapy, no combined modality has consistently improved survival over the achieved with radical cystectomy alone in patients with T3b disease. Additionally, continent stomal diversions and orthotopic neobladders allow almost normal continence and voiding in both male and female patients, which calls into question the need for bladder preservation. Although no single treatment modality or urinary diversion is right for all patients, a radical cystectomy with continent diversion provides the best chance for survival and allows the best postoperative quality of life. If bladder preservation treatments are used, inclusion in a clinical trial is recommended.
传统上，膀胱T3b期移行细胞癌（TCC）患者接受根治性膀胱切除术和尿流改道治疗，但全身化疗的初步成功以及对生活质量问题的重新关注，增加了人们对膀胱保留治疗的兴趣。不幸的是，尽管进行了多项使用有限手术程序以及新辅助或辅助化疗的试验，但在T3b期疾病患者中，没有一种联合治疗方式能持续改善生存率，使其超过单纯根治性膀胱切除术所达到的生存率。此外，可控性造口尿流改道和原位新膀胱可使男性和女性患者几乎实现正常的控尿和排尿，这引发了对膀胱保留必要性的质疑。尽管没有单一的治疗方式或尿流改道方法适用于所有患者，但根治性膀胱切除术加可控性尿流改道提供了最佳的生存机会，并能带来最佳的术后生活质量。如果采用膀胱保留治疗，建议纳入临床试验。
