在合并症情况下对尿道癌患者进行器官切除治疗

M. Ter-Ovanesov, D. M. Yagudaev, A. Gritskevich, A. V. Umyarova, V. A. Bezhenar
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摘要

尿道恶性肿瘤极为罕见。膀胱恶性肿瘤的发病率为 1:5000000,占所有膀胱癌病例的 0.35-1.2%。文献中描述的少量观察结果无法让我们对该病症的最佳诊断和治疗方法做出可靠的统计和明确的建议。尿道疾病的诊断通常具有挑战性。这与该病的无症状病程和临床表现多种多样有关。治疗策略在很大程度上也是模糊的,从手术治疗适应症的确定到手术干预的积极性。同时,20% 的泌尿道癌患者在发现时已有远处转移。鉴于上述情况(发病率低、研究成果少、血流凶险),对这种疾病的每一次临床观察都很有价值。本文是一篇临床观察报告,提供了对一名患有多种疾病的患者进行膀胱癌诊断、策略选择和手术治疗的信息。该患者在大血尿的补充检查中发现膀胱体积增大。膀胱镜检查和经尿道切除术以及随后的形态学检查证实,膀胱浸润性粘液腺癌向固有层生长,没有血管和神经周围侵犯的迹象。患者接受了开腹手术、膀胱根治性切除术和盆腔淋巴结扩大切除术。在手术过程中,脐部、尿道、膀胱壁和肿瘤以及邻近的腹膜被一并切除。形态学检查证实为尿道粘液腺癌。术后恢复顺利,10 个月的随访期间未发现疾病进展迹象。
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The organ sparing management of a patient with urachus cancer in conditions of comorbidity
Malignant tumors of the urachus are extremely rare. The frequency of urachal malignancy makes 1: 5 000 000 cases, which is 0.35–1.2 % of all the cases of bladder cancer. The small series of observations described in the literature do not allow us to formulate statistically reliable and unambiguously recommended statements about the optimal methods of diagnostics and treatment of this pathology. The diagnosis of urachus diseases is often challenging. This is associated with both the asymptomatic course and the variety of clinical flow of the disease. The treatment strategies are also largely ambiguous and ranging from the defining the indications for surgical treatment to the aggressiveness of surgical intervention. Meanwhile, 20 % of patients with urachal cancer have distant metastases at the time of detection. With everything listed above, (low frequency, little research done and aggressiveness of the flow) it makes every clinical observation of this disease valuable.This article is a clinical observation providing with the information upon the diagnosis, the choice of strategies and surgical treatment of urachal cancer in a patient suffering from multimorbidity. Volumetric formation of the bladder was detected in this patient during additional examination for macrohematuria. Cystoscopy with transurethral resection and subsequent morphological examination verified invasive mucinous adenocarcinoma of the bladder with the growth into the lamina propria and without the signs of vascular and perineural invasion. The patient underwent laparotomy, radical resection of the bladder with extended pelvic lymphadenectomy. The umbilicus, urachus and the bladder wall with the tumor, as well as the adjacent peritoneum, were excised as a single block during the surgical intervention. Morphological examination verified mucinous adenocarcinoma of urachus. The postoperative period was uneventful.There have been no signs of disease progression observed during 10-month follow-up period.
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