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手术处理翻译

发表时间:2018-12-5  浏览次数:34  
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原文:

It is important to recognize an urachal tumor preoperatively in order to plan for the correct surgical procedure aimed toward controlling the primary tumor site. Urachal tumors may arise anywhere along the urachal ligament and even extend up through the ligament commune to the umbilicus1; therefore, controlling this structure with an intact resection is imperative to decrease the patient’s risk of relapse. Given the usual presentation in the dome of the bladder and the absence of a field effect placing the remaining urothelium at risk of recurrence, a partial cystectomy with en-bloc resection of the urachal ligament with the umbilicus and bladder is most commonly recommended. When this ligament is not resected intact with the umbilicus and the dome of the bladder, there is a higher risk of relapse. This author has seen many cases referred from off-site centers when resection of the ligament just below the umbilicus led to rupture of cystic contents into the peritoneal cavity with ultimate relapse with peritoneal carcinomatosis. A complete cystectomy with en-bloc resection of the urachal ligament and umbilicus should be considered if necessary to obtain negative margins or if the extent of resection would result in an inadequate functional urinary reservoir. Contemporary series suggest that long-term survivors are routinely seen with this surgical approach with a median survival of approximately 48 months and 5-year survival rates of 45%–49%.

 

译文:

为设计正确的手术操作,控制原发肿瘤病灶,术前确诊脐尿管肿瘤非常重要。脐尿管肿瘤可沿脐尿管韧带发生于任何部位,甚至向上延伸穿过韧带与脐相通;因此,为降低患者复发风险,运用完全切除术控制该结构是必须的。由于脐尿管癌通常出现于膀胱顶部,以及缺乏判断存在复发风险的剩余尿路上皮的场效应,通常推荐行部分膀胱切除术,并将连接脐和膀胱的整个脐尿管韧带切除。如韧带没有与脐和膀胱圆顶一起整个切除,复发风险较高。本研究者见过许多相关病例,如只从脐下部切除韧带,就会导致膀胱破裂,内容物进入腹腔,最终复发出现腹膜扩散。必要时应考虑实施膀胱完全切除术以及脐尿管韧带和脐的完全切除术,使手术边界无癌。再者,切除时有可能影响膀胱的储尿功能。同期患者组表明,运用该手术方式的长期存活患者的生存中值约为48个月,5年生存率为45%-49%。

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