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目的:提高对原发性膀胱黏液腺癌(包括非脐尿管型和脐尿管型)的诊疗水平,评估预后。方法:回顾分析我院2005年6月~2013年6月收治的18例原发性膀胱黏液腺癌患者,其中非脐尿管型12例,脐尿管型6例。男12例,女6例。平均年龄60(45~78)岁。间歇性、无痛性肉眼血尿为主要就诊症状。手术治疗17例,1例患者全身状况较差未行手术治疗,7例患者术后给予辅助化疗。结果:18例病理报告均为膀胱黏液腺癌,其中脐尿管源性6例。病理分期:T1期3例,T2期8例,T3期5例,T4期1例,未手术患者无病理分期。病理分级:高分化8例、中分化10例。免疫组化:CK7、CK20、EMA、Ki-67、Leu-M1、CEA均+,Vimentin均-,仅3例PSA+。17例平均随访17.5(5~68)个月,1例失访。1年生存率58.8%(10/17),2年生存率40.0%(6/15),5年生存率33.3%(4/12)。结论:原发性膀胱黏液腺癌少见,造成预后差最重要的因素就是不易早期诊断,根治性膀胱切除术为本病最主要的治疗手段,肿瘤大小对术后生存期有一定影响,术后配合放疗或化疗等综合治疗可延长患者生存期。
Objective: To improve the diagnosis and treatment of primary bladder mucinous adenocarcinoma (including non-uvula type and uvula type) and assess the prognosis. Methods: 18 cases of primary mucinous adenocarcinoma of the bladder treated in our hospital from June 2005 to June 2013 were retrospectively analyzed. Among them, 12 cases were non-urachal type and 6 cases were uvula type. There were 12 males and 6 females. The average age of 60 (45 ~ 78) years old. Intermittent, painless gross hematuria as the main treatment symptoms. Surgical treatment in 17 cases, 1 case of poor general condition without surgery, 7 patients were given adjuvant chemotherapy. Results: 18 cases of pathological reports were bladder mucinous adenocarcinoma, of which 6 cases of uroplasias. Pathological staging: T1 in 3 cases, T2 in 8 cases, T3 in 5 cases, T4 in 1 case, no surgery patients without pathological staging. Pathological grading: 8 cases of well-differentiated, moderately differentiated in 10 cases. Immunohistochemistry: CK7, CK20, EMA, Ki-67, Leu-M1, CEA were +, Vimentin were -, only 3 cases of PSA +. 17 cases were followed up for an average of 17.5 (5-68) months, and 1 case was lost. The 1-year survival rate was 58.8% (10/17), 2-year survival rate was 40.0% (6/15), and 5-year survival rate was 33.3% (4/12). Conclusion: The most common cause of poor prognosis is the rare primary mucinous adenocarcinoma of the bladder, which is not easy to be diagnosed early. Radical cystectomy is the most important treatment for this disease. The size of the tumor has a certain impact on the postoperative survival rate. Combined with radiotherapy or chemotherapy and other comprehensive treatment can extend the patient’s survival.