本文报道一例膀胱癌根治术后盆腔复发的病例。患者因“膀胱癌术后9 年，盆腔占位进行性增大2 年”入院。PET-CT 提示膀胱癌根治术后，盆腔右侧囊实性肿块，考虑恶性病变，考虑代膀胱肠管来源或膀胱癌复发，病灶累及右侧髂血管、右闭孔内肌、左输尿管再造入口，伴以上左输尿管、左肾积液，病变局部与邻近乙状结肠、小肠分界不清，骶前结节糖代谢异常增高，考虑转移。经广东省医学会泌尿外科疑难病例多学科会诊，专家认为手术难度大，建议先取病理活检，明确病理后予化疗治疗，视疗效再评估手术切除。遂行超声引导下盆腔肿物穿刺活检，病理结果提示尿路上皮癌转移，予GC 方案（吉西他滨1 600 mg+洛铂 45 mg）化疗。患者化疗一个多月后复查CT，肿瘤较前无明显变化，专家建议继续化疗或参加临床药物试验。目前仍在化疗中，观察疗效后再讨论下一步治疗方案。膀胱癌术后盆腔复发预后较差，肿瘤粘连严重，手术难度大、风险高，超声引导下穿刺活检有优势，治疗上需个体化，提供放疗、化疗、手术或联合治疗。

This article reports a case of pelvic recurrence after radical cystectomy for bladder cancer.The patient was admitted to the hospital due to "progressive increase of pelvic mass for 2 years after radical cystectomy for bladder cancer 9 years".PET-CT showed a cystic and solid mass on the right side of the pelvis after radical cystectomy， which was considered a malignant lesion， possibly from the intestinal substitute bladder or recurrence of bladder cancer.The lesion involved the right iliac vessels， the right obturator internus muscle， and the left ureteral stoma， accompanied by hydronephrosis of the left kidney and hydroureter of the left ureter.The local lesion was indistinguishable from the adjacent sigmoid colon and small intestine， and there was a presacral nodule with abnormally increased glucose metabolism， suggesting metastasis.After multidisciplinary consultation on difficult cases in Guangdong Urological Association， experts considered that the surgery was difficult and recommended taking a biopsy first to confirm the pathology and then give chemotherapy.The surgery would be re-evaluated based on the therapeutic effect.Subsequently， a biopsy of the pelvic mass was performed under ultrasound guidance， and the pathological result indicated metastatic urothelial carcinoma.The patient was treated with GC chemotherapy （gemcitabine 1 600 mg + lobaplatin 45 mg）.The patient underwent a follow-up CT scan after over a month of chemotherapy， which showed no significant changes in tumor size compared to previous imaging.Experts recommend continuing chemotherapy or participating in clinical drug trials.The patient is currently continuing chemotherapy， and the next treatment plan will be reassessed after monitoring the therapeutic effects.The prognosis of pelvic recurrence after bladder cancer surgery is poor， with severe tumor adhesion， high surgical difficulty and risk.Ultrasound-guided biopsy has advantages.Treatment should be individualized， providing radiotherapy， chemotherapy， surgery or combined treatment.