保留器官手术治疗尿道癌(1例临床)

N. Kholopova, V. B. Venskel, N. Kovalenko, V. Zhavoronkova, A. I. Ivanov, A. G. Chuhnin, A. A. Klimchenko
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引用次数: 0

摘要

背景。尽管发病率低,恶性尿道肿瘤是最具侵袭性的肿瘤之一。肌肉侵袭性和转移性癌症在诊断时的患病率,以及高复发率迫使坚持最激进的治疗。同时,中老年患者尿道肿瘤的高发和术后并发症的高发生率,也为器官保留治疗的发展提供了必要的条件。以病例说明验证器官保留治疗在尿道癌中的适用性。材料和方法。我们报告在伏尔加格勒地区临床肿瘤药房的肿瘤学单位治疗经验老年患者合并慢性肾脏疾病。考虑到年龄、伴发病理及肿瘤组织学因素,采用微创保器官手术干预,腹腔镜尿道切除术联合输尿管膀胱造口术。结果和讨论。术后通过动态肾显像和血肌酐监测评估肾功能。对照膀胱、输尿管镜及感兴趣区域CT增强扫描排除复发和进展。在随访中没有疾病复发或进展的报告表明在这类患者中器官保留手术的肿瘤学安全性。该方法还获得了患者肾功能改善和持续良好生活质量的即时和长期结果的支持。
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Organ-Preserving Surgery in Urethral Cancer (a Clinical Case)
Background. Despite low incidence, malignant urethral neoplasms are among the most aggressive tumours. Prevalence of muscle-invasive and metastatic cancer at diagnosis, as well as a high relapse rate compel adherence to the most radical treatment. At the same time, the high incidence of urethral tumours in elderly and senile patients and high postoperative complication rates warrant the development of organ-preserving treatment.Aim. A case description to verify the organ-preserving treatment applicability in urethral cancer.Materials and methods. We report the treatment experience in a senile patient with concomitant chronic kidney disease at the Volgograd Regional Clinical Oncology Dispensary’s Oncourology Unit. Accounting for the age, concomitant pathology and tumour histology factors, a minimally invasive organ-preserving surgical intervention was performed as laparoscopic urethral resection with ureterocystoneostomy.Results and discussion. Renal function was assessed in postoperative period with dynamic nephroscintigraphy and blood creatinine monitoring. Control cysto-, ureteroscopy and contrast-enhanced CT scanning in areas of interest were performed to rule out relapse and progression.Conclusion. No report of disease relapse or progression at follow-up indicates the oncological safety of organ-preserving surgery in this patient category. Th is approach also gains support from immediate and long-term outcomes of the patient’s improved renal function and sustained good quality of life.
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