TURBT联合膀胱内BCG灌注治疗肌层浸润性膀胱癌疗效分析  

TURBT combined with BCG intravesical instillation for muscle-invasive bladder cancer

作　　者：李海峰[1] 孙卫兵[2] 包国昌[1] 高志明[1] 李明辉[1] 夏海波[1] 

机构地区：[1]赤峰学院附属医院(新城)泌尿外科,024000 [2]大连医科大学附属第二医院泌尿外科

出　　处：《现代泌尿生殖肿瘤杂志》2017年第3期151-155,共5页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的探讨选择性经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)治疗经选择的肌层浸润性膀胱尿路上皮癌患者保留有功能性膀胱的可行性。方法回顾性分析大连医科大学附属第二医院2006年至2011年间323例行TURBT治疗的膀胱尿路上皮癌患者的临床资料,选择术前影像学检查无明显膀胱外浸润,肿瘤单发,直径5cm以下,局限于膀胱顶壁、底壁及侧壁,距输尿管口1cm以上,不伴有原位癌,肿瘤创缘及基底部活检为阴性的T2期患者为研究对象,接受选择性TURBT伴膀胱内灌注BCG的保膀胱治疗。术后膀胱镜密切随访5~10年,运用统计学分析生存率、疾病特异生存率和无复发生存率评价疗效。结果入组31例患者,5年总体生存率、疾病特异生存率和无复发生存率分别为87%、93%和58%。复发15例,浅表性复发6例,8例接受延迟膀胱癌根治术。23例保留有功能性膀胱,死亡6例。结论选择性TURBT治疗肌层浸润性膀胱癌在少部分经严格选择的患者中是合理可行的,术后患者应终生接受膀胱镜严密随访。Objective To investigate the feasibility of bladder preservation by selective transurethral resection for patients with muscle-invasive bladder cancer. Methods From 2006 to 2011,323 patients of urothelial bladder carcinoma treated by transurethral resection in our hospital were retrospectively reviewed,and bladder preservation was considered for patients with stage T2 who had a solitary,small（〈5cm）tumor confined to the dome,bottom and lateral wall of the bladder without extravesical invading on imaging which was more than 1cm apart from urethra orifice without the presence of carcinoma in situ and negative biopsies of the tumor bed.All ideal patients received intravesical BCG instillation after radical transurethral resection and were followed up by routine cystoscopy for 5to 10 years.The overall,disease-specific and recurrence-free survival rates were analysed to evaluate this treatment. Results Of 323 patients,31（6.7%）were eligible for bladder preservation.The five-year overall,disease specific and recurrence-free survival rates were 87%,93% and 58%,respectively.Of the 31 patients,15（48%）patients had tumor recurrence,6（20%）of whom had superficial recurrence in the bladder and 8（26%）of whom had to be opted for salvage cystectomy.In total,the bladder was preserved in 74%（23/31）patients successfully,but six patients died at last. Conclusions Bladder preservation by selective transurethral resection is feasible in only a small proportion of highly selected patients.And a closer lifelong follow-up with cystoscopy is recommended.

关 键 词：肌层浸润性膀胱癌 经尿道膀胱肿瘤电切术 

分 类 号：R737.14[医药卫生—肿瘤]