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目的提高对原发性膀胱印戒细胞癌的认识和诊治水平。方法回顾分析我院收治的2例原发性膀胱印戒细胞癌,结合文献就其临床表现、诊断及治疗进行讨论。第1例患者,男,57岁,以全程肉眼血尿和继发的贫血就诊,CT检查示膀胱顶部占位性病变,界限清楚,有斑点状钙化。第2例患者,男,66岁,以黏液尿就诊,无其他临床表现,CT示膀胱右侧壁占位性病变。均于术前膀胱镜活检明确诊断。第1例因患者拒绝膀胱全切除术行膀胱部分切除术加脐尿管和相邻腹膜的切除术,第2例因陈旧性心肌梗塞行膀胱部分切除术。结果第1例患者术后血尿消失,贫血纠正。7个月后发现肺部转移,术后8个月死亡。第2例术后黏液尿和膀胱刺激症状消失。随访37个月,患者恢复良好,无复发和转移。结论原发性膀胱印戒细胞癌临床罕见,预后较差,诊断主要依赖病理学检查,全膀胱切除术是其首选治疗方法。
Objective To improve the understanding and diagnosis and treatment of primary signet ring cell carcinoma of the bladder. Methods Two cases of primary signet ring cell carcinoma of the bladder treated in our hospital were retrospectively analyzed. Their clinical manifestations, diagnosis and treatment were discussed in combination with the literature. The first patient, male, 57 years old, was treated with gross hematuria and secondary anemia. A CT scan revealed a space-occupying lesion on the top of the bladder with well-defined calcification. The second patient, male, 66 years old, was treated with mucinous urine and had no other clinical manifestations. CT showed a space-occupying lesion on the right side of the bladder. Preoperative cystoscopy clear diagnosis. The first patient underwent total cystectomy with partial cystectomy plus removal of the urachus and adjacent peritoneum. The second patient underwent partial cystectomy due to an obsolete myocardial infarction. Results The first patient disappeared after hematuria and anemia was corrected. Pulmonary metastases were found after 7 months and died 8 months after surgery. The second case of postoperative mucus and bladder irritation disappeared. After a follow-up of 37 months, the patients recovered well without recurrence and metastasis. Conclusions Primary bladder signet ring cell carcinoma is rare in clinical practice, and its prognosis is poor. The diagnosis mainly depends on pathological examination and total cystectomy is the first choice of treatment.