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目的探讨侵犯膀胱的局部晚期结直肠癌的临床特点及诊治方法。方法收集中国医学科学院肿瘤医院1999年1月至2008年8月所收治的72例侵犯膀胱的局部晚期结直肠癌患者的临床资料,回顾性分析其临床特点和治疗方式对患者生存期的影响。结果共有72例结直肠癌患者在手术时发现肿瘤与膀胱相粘连,其中67例患者行膀胱部分切除术,5例患者行全膀胱切除术。所有患者术后总并发症发生率为22.2%。术后病理结果显示,在39例(54.2%)患者中肿瘤已侵犯膀胱,而33例(45.8%)患者仅为炎性粘连。术后患者总5年生存率为58.2%,淋巴结阴性患者占68.0%,淋巴结阳性患者占29.0%。结论对于侵犯膀胱的局部晚期结直肠癌患者,行联合膀胱切除的肿瘤整块切除可获得满意的远期疗效。手术切缘阴性及无淋巴结转移患者可获得良好预后。
Objective To investigate the clinical features and diagnosis and treatment of locally advanced colorectal cancer with bladder invasion. Methods The clinical data of 72 patients with locally advanced colorectal cancer with bladder invasion collected from January 1999 to August 2008 in Cancer Hospital of Chinese Academy of Medical Sciences were collected. The clinical characteristics and the effect of treatment on survival were collected. Results A total of 72 patients with colorectal cancer were found to have tumor adhesion to the bladder at the time of surgery. Sixty-seven patients underwent partial cystectomy and five patients underwent total cystectomy. The overall postoperative complication rate was 22.2% in all patients. Postoperative pathologic findings showed that the tumor had invaded the bladder in 39 (54.2%) patients, whereas 33 (45.8%) had inflammatory adhesions alone. The overall 5-year survival rate was 58.2% in postoperative patients, 68.0% in patients with node-negative disease, and 29.0% in patients with node-positive disease. Conclusions For the patients with locally advanced colorectal cancer with bladder invasion, the successful long-term curative effect can be obtained by en bloc resection combined with cystectomy. Patients with negative surgical margins and no lymph node metastases have good prognosis.