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Treatment department: Department of Urology and Oncology Treatment cost: about (5000-20000 yuan) in the city's top three hospitals Cure rate: Treatment cycle: Treatment methods: drug treatment, surgical treatment, radiotherapy General treatment of paraurethral adenocarcinoma
Western medicine treatment of paraurethral adenocarcinoma
1. Surgical treatment
(1) Low-stage urethral cancer:
①It is limited to urethral cancer with extremely superficial mucosa, which can be treated with laser or electrocautery. If recurrence occurs, the treatment can be repeated. Avoid burning too deep and forming a stricture of the urethra.
②Small tumors of low stage can be seen on the outside of the anterior urethra, which can be resected locally, and are limited to mucosal or submucosal tumors.
③For anterior urethral cancer, partial urethral resection is feasible for O, A and B stages.
④For stage B or C urethral cancer, bladder and total urethra resection can be performed in selective cases. Partial urethral resection for anterior urethral cancer cannot guarantee cancer-free urethral resection margins. Total urethral resection can be considered. Controllable urinary diversion was reconstructed after total urethraectomy.
(2) High-stage urethral cancer: advanced cases where the tumor has infiltrated the entire urethra, bladder, and vagina should be treated with combined therapy. Anterior pelvic organ resection, including pelvic lymph nodes and all the urethra, bladder, uterus and appendages, anterior and lateral vaginal walls, symphysis pubis and descending pubic branch, and urinary diversion. This operation is not effective for invasive cancer, the 5-year survival rate is only 10% to 17%, local recurrence can be as high as 66% to 100%, and there are many complications, such as osteomyelitis, sacroiliac joint instability, rectovaginal fistula, perineum Hernias, pelvic abscesses, and suprapubic branch fractures.
2. Radiation therapy
Radiotherapy is suitable for the treatment of urethral cancer in all stages, and radiotherapy alone is used for stage O, A or a small number of stage B patients. Radiotherapy methods include single-line brachytherapy with interstitial interstitial radiotherapy, or interstitial interstitial radiotherapy with external beam radiation therapy, or preoperative external radiotherapy with surgery. The local control rate of well-differentiated localized urethral cancer using interstitial interstitial radiotherapy alone can reach 75%. When the surrounding tissues of the urethra are affected, the local control rate drops to 50%. In this case, small field irradiation combined with interstitial insertion, or external radiotherapy combined with surgical treatment is more appropriate. 4000～5000cGy/4～6 weeks of external irradiation, 2000～3000cGy inserted between the tissues.
When radiotherapy is inserted between tissues around the urethra through the perineum, a urinary tube can be inserted into the urethra before insertion, and a columnar marker can be inserted into the vagina to guide the needle insertion direction. If necessary, cystotomy can be performed under general anesthesia, and needle insertion can be guided. After the needle is inserted, the film is positioned under the simulated positioning machine, and then the radiotherapy plan is drawn up, and finally sent to the after-installation treatment room for radiotherapy. The dose of interstitial radiation therapy is usually 6000～7000cGy. After radiotherapy, radiation urethral and bladder mucositis is prone to occur. It usually occurs 1 day to 2 weeks after radiotherapy and lasts for 4 to 6 weeks. The clinical manifestations are dysuria and urinary tract irritation. Late complications can be manifested as mucosal necrosis, urethovaginal fistula, vesicovaginal fistula, radiation enteritis and intestinal obstruction. Strict selection of cases, fine insertion techniques and good care after radiotherapy in the radiotherapy area can significantly reduce the incidence and severity of complications.
Preoperative radiotherapy plus surgical treatment is suitable for patients with stage B and C. The preoperative radiotherapy adopts external irradiation. The pelvic cavity has four fields. The total dose is 5000cGy (25 times·5 weeks). The radiotherapy is performed 4-6 weeks after the radiotherapy. Operation. The scope of surgical resection is similar to that of bladder cancer, that is, radical cystourethrectomy and upper bladder urinary tract diversion, and radical surgery within 3 weeks of urinary tract diversion. If the lesion involves the vagina, a perineal vaginectomy is required, and an omental flap is used to fill the ineffective vaginal cavity to prevent the pelvic contents from sagging and the formation of intestinal hernias. When the disease involves the symphysis pubis, pubic resection is required. The treatment of inguinal lymph node metastasis is similar to the treatment of vulvar cancer, with inguinal lymph node dissection. The significance of routine preventive pelvic lymph node dissection is uncertain. This treatment is used for high-risk patients who are at risk of pelvic lymph node metastasis.
The role of chemotherapy is uncertain, and it is mainly used in D stage and advanced cases. Anticancer drugs such as doxorubicin (doxorubicin), bleomycin and dacarbazine (dacarbazine) can be used as adjuvant therapy to radiotherapy. When the pelvic lymph nodes have metastasized, arterial chemotherapy can be done, followed by surgery, which may improve the curative effect.
Syndrome Differentiation and Treatment of Paraurethral Adenocarcinoma
TCM treatment of paraurethral adenocarcinoma
1. Traditional Chinese Medicine Recipe: (The following information is for reference only, you need to consult a doctor for details)
1. 7 grams of Mutong, 10 grams of Plantago, 10 grams of Dianthus, 10 grams of dianthus, 20 grams of talc, 10 grams of gardenia, 6 grams of rhubarb, and 5 grams of licorice.
2. Codonopsis 10 grams, Fried Atractylodes 15 grams, Poria 24 grams, Coix 30 grams, Amomum villosum 7 grams, Alisma 15 grams, Angelica 10 grams, Kun grass 30 grams, Tangerine peel 10 grams.
3. 10 grams of peach kernels, 10 grams of safflower, 15 grams of angelica, 6 grams of fennel, 10 grams of Chinese neem, 10 grams of black medicine, 12 grams of red peony, 15 grams of Eupatorium, and 30 grams of dandelion.
4. Anemarrhena 15g, Phellodendron 10g, Rehmannia glutinosa 30g, Alisma 15g, Paeonol 15g, Poria 30g, Shouwu 15g, Polygonatum 15g, Baiteng 10g, Salvia 15g.
5. Prepare 10 grams of attached tablets, 10 grams of dodder, 10 grams of Xianling spleen, 10 grams of Eucommia, 10 grams of Polygonatum, 15 grams of Angelica, 15 grams of Chinese Yam, and 24 grams of Poria.
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