经尿道二次电切治疗非肌层浸润性膀胱肿瘤的临床研究  

The clinical research of repeat transurethral resection for non-muscle invasive bladder tumor

作　　者：胥金斌[1] 徐建林[1] 邵建中[1] 

机构地区：[1]江苏省宝应县人民医院泌尿外科,225800

出　　处：《临床外科杂志》2013年第2期103-105,共3页Journal of Clinical Surgery

摘　　要：目的观察经尿道二次电切术（repeattransurethralresection，ReTUR）治疗非肌层浸润性膀胱肿瘤的的临床疗效。方法使用经尿道膀胱肿瘤电切术（transurethralresectionofbladdertumor，TURBT）治疗的187例术后病理证实为非肌层浸润性尿路上皮癌患者中根据肿瘤突破黏膜层（T．期）为高级别癌及术后标本有无肌层组织筛选出63例患者，排除含因肿瘤波及范围较广而改行膀胱癌根治术或因某些原因而未继续治疗的患者。所有患者均于术后4～7周行ReTUR术，术后第一天即开始规范化疗，记录其手术效果及并发症。结果63例行ReTUR术的患者中40例（63．5％）发现无肿瘤残留，23例（36．5％）有肿瘤残留；术后病理检查证实：19例残留肿瘤未侵及肌层，其中Ta期11例，T，期8例；4例（17．4％）肿瘤侵及肌层均为高级别癌。8例（12．7％）在初次切除时肿瘤分期被低估，Ta期、T．期各为4例。ReTUR术中3例（4．8％）发生膀胱穿孔；2例发生膀胱出血。所有均获随访，随访6～48个月，平均（24±1．5）个月。结论TUR治疗膀胱非浸润性膀胱癌术后容易复发或进展，应于初次手术后4～7周常规行ReTUR术，能早期发现及清除残留复发的肿瘤，并可提高肿瘤分期的准确性及时优化治疗方案，提高患者的长期生存率。Objective To investigate the efficacy of repeat transurethral resection （ReTUR）for non-muscle invasive bladder tumor. Methods A total of 187 patients with non-muscle invasive bladder urothelial cancer who underwent transurethral resection of bladder tumor（TUR） and were confirmed by pa- thology were reviewed. Sixty-three patients were enrolled according to the invasion of the mucous layer （ stage T1 ） and the muscular tissue residue of the initial transurethral resected sample. Patients who did not follow the scheduled treatment and who underwent radical cystectomy for a wide range of the tumor were ruled out. All 63 patients underwent ReTUR within 4 - 7 weeks after initial resection. On the first day after operation, standard chemotherapy began. Efficacy and complication of the procedures were recorded. Re- suits Of the 63 cases, 36.5% （ 23/63 ） of the patients had residual neoplasms and 63.5% （ 40/63 ） of them had not. Postoperative pathologic examination confirmed 19 cases had non-muscle invasive tumor, in- eluding 11 cases in Ta and 8 cases in T1 ; Four cases with residual neoplasms were all high-grade carcino- ma. Eight cases（ 12.7% ）were understaged at the initial resection,including 4 cases in Ta and 4 cases in T1. Three cases of the ReTUR （4.8%） had bladder perforation and 2 （3. 1% ） had bleeding during Re- TUR. All cases were followed up for 6 - 48 months （mean,24 ± 1.5 months）. Conclusion Treating non- muscle invasive bladder cancer with TUR has a high rate of recurrence and progression. Performing ReTUR routinely within 4 - 7 weeks after initial resection is helpful in finding and eliminating the residual neo- plasms,which may definite the pathological staging, optimize the therapeutic schedule and improve the long-term survival rate.

关 键 词：膀胱肿瘤 经尿道膀胱肿瘤二次电切术 经尿道膀胱肿瘤电切术 

分 类 号：R737.14[医药卫生—肿瘤]