5-氨基乙酰丙酸诱导荧光膀胱镜在膀胱肿瘤诊断中的应用(附34例报告)  

Detection of bladder cancer using 5-aminolevulinic acid induced fluorescence endoscopy (report of 34 cases)

作　　者：宋晓东[1] 叶章群[1] 周四维[1] 杨为民[1] 刘继红[1] 马扬之[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030

出　　处：《中华泌尿外科杂志》2004年第9期619-621,共3页Chinese Journal of Urology

基　　金：国家自然科学基金资助项目 ( 3 0 2 713 0 0 )

摘　　要：目的　探讨 5 氨基乙酰丙酸 (5 ALA)诱导荧光光动力学诊断对膀胱肿瘤早期诊断的价值。　方法　 34例血尿患者行 5 ALA诱导荧光染色膀胱镜检及活组织检查 :以 5 ALA缓冲液灌注膀胱 ,2～ 3h后 ,用D LIGHT系统进行荧光膀胱镜检 ,对荧光阳性区域及白光下肉眼观有异常但荧光阴性的区域进行活检。活检结束后行经尿道电切术 (TUR)。　结果　 31例呈荧光阳性 ,其中 2 6例为尿路上皮癌 ,5例为良性病变 ;3例呈荧光阴性 ,其中腺性膀胱炎 2例 ,出血性膀胱炎 1例。 11例移行细胞癌患者于癌旁或远处发现普通膀胱镜下无法识别的微小荧光阳性区域 ,经活检均证实有肿瘤存在 ,其中 2例为原位癌。 6 1处活检结果经统计分析 ,该诊断方法对膀胱肿瘤的灵敏度为 97.6 %(4 1/ 4 2 ) ,特异性为 4 7.4 % (9/ 19)。　结论　 5 ALA诱导荧光光动力学诊断对膀胱肿瘤诊断有较高价值 ,能发现早期肿瘤 ,同时可彻底进行电切除。Objective To evaluate the value of photodynamic diagnosis for early detection of bladder cancer using 5-aminolevulinic acid (5-ALA) induced fluorescence. Methods A total of 34 cases of painless gross hematuria underwent 5-ALA induced fluorescence endoscopy and biopsy.The procedure was as follows: after instillation of 5-ALA in the urinary bladder for 2 to 3 hours,biopsies were taken from lesions that were either fluorescing or nonfluorescing using fluorescence endoscopy by D-LIGHT system;and then TUR was performed on them. Results Of the 34 cases, 31 were found fluorescence-positive.Histopathologic examination showed that 26 of them were of urothelial cell carcinoma,5 were of benign lesions.The other 3 cases were fluorescence-negative,including 2 cases of cystitis glandularis and 1 case of hemorrhagic cystitis.In the 11 cases of transitional cell carcinoma,flat small fluorescence-positive lesions were found in peri-tumoral or other regions,which could not be detected by white light cystoscopy,but were histologically confirmed to be transitional cell carcinoma (2,in situ).Statistic analysis indicated a specificity of 47.4% and a sensitivity of 97.6%. Conclusions Photodynamic diagnosis using 5-ALA induced fluorescence endoscopy is useful for detection of early bladder cancer and helpful to radical TUR.

关 键 词：5-氨基乙酰丙酸 荧光膀胱镜 膀胱肿瘤 5-ALA 光动力学 

分 类 号：R737.14[医药卫生—肿瘤]