根治性膀胱切除术前行最大限度TURBT对膀胱多发肿瘤预后的影响  

Effect of maximum TURBT before radical cystectomy on the prognosis of multiple bladder tumors

作　　者：拜合提亚尔·艾合买提江 王文光[1] 李晓东[1] 凯赛尔·阿吉[1] 木拉提·热夏提[1] Baihetiyaer·Aihemaitijiang;Wang Wenguang;Li Xiaodong;Kaisar-er·Aji;Mulati·Rexati(Department of Urology,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院泌尿外科,乌鲁木齐830054

出　　处：《中华泌尿外科杂志》2021年第4期268-273,共6页Chinese Journal of Urology

基　　金：国家自然科学基金(81760123)。

摘　　要：目的探讨根治性膀胱切除术(RC)前行最大限度经尿道膀胱肿瘤切除术(TURBT)对膀胱多发肿瘤患者预后的影响。方法回顾性分析新疆医科大学第一附属医院2010年8月至2018年8月收治的90例行RC的膀胱多发肿瘤患者的临床资料及随访记录。男72例,女18例。平均年龄(64.6±11.7)(20~84)岁,<60岁50例,≥60岁40例;男性中位年龄68岁,女性中位年龄69岁。肿瘤直径≥3 cm 52例,<3 cm 38例。肿瘤病灶为2处53例,>2处37例。根据TURBT切除范围将患者分为最大限度组和诊断性电切组。最大限度组55例(61.1%),男42例,女13例;平均年龄(56.2±12.0)岁;肿瘤直径≥3 cm 29例,<3 cm 26例。诊断性电切组35例(38.9%),男30例,女5例;平均年龄(59.8±13.4)岁;肿瘤直径≥3 cm 23例,<3 cm 12例。两组术前资料比较差异均无统计学意义(P>0.05)。最大限度组于电切镜下完整切除所有肉眼可见的肿瘤,并从基底部和周围黏膜取组织单独送病理检查。诊断性电切组:术中发现膀胱内多发肿物,表面粗糙,并且两侧输尿管口未见,在肿瘤较多处、输尿管口及周围黏膜组织取标本送活检,膀胱内肿瘤未全切除。两组患者术后均行RC。分析两种术式与各临床病理因素的关系。采用Kaplan-Meier法分析膀胱多发肿瘤患者无复发生存率(RFS)和总生存率(OS),并采用log-rank法分析生存曲线的差异。采用单因素log-rank与多因素Cox回归分析RFS和OS的影响因素。结果本研究90例RC均顺利完成,术后中位随访时间30(15~46)个月,失访1例。RC术后尿道复发6例(6.7%),盆腔复发9例(10.0%)。死亡15例(16.7%),其中8例因术后盆腔复发死亡,3例因心肌梗死死亡,2例因骨转移死亡,2例因肺转移死亡。Kaplan-Meier法结果显示,最大限度组RC术后1、3、5年OS分别为96.67%、86.05%、80.86%,1、3、5年RFS分别为89.97%、76.93%、71.41%。单因素分析结果显示,病理分期(P=0.018)、尿道复发(P<0.01)、盆腔复发(P<0.01)、最大Objective to investigate the effect of maximum transurethral cystectomy((TURBT))before radical cystectomy on the prognosis of patients with multiple bladder tumors.Methods the clinical data and follow-up records of 90 patients with multiple bladder tumors treated in our hospital from August 2010 to August 2018 were analyzed retrospectively.There were 72 males and 18 females.The age ranged from 20 to 84 years old,with an average of(64.6±11.7)years.There were 50 cases of age<60 years old and 40 cases of≥60 years old.The median age of male was 68 years old and that of female was 69 years old.The diameter of Tumor was≥3 cm in 52 cases and<3 cm in 38 cases.There were 53 cases with 2 lesions and 37 cases with more than 2 lesions.According to the extent of TURBT resection,55 patients(61.1%)were divided into maximum TURBT group,42 males and 13 females,with an average age of(56.2±12.0)years.Tumor diameter≥3 cm(n=29)and<3 cm(n=26).There were 35 cases(38.9%)in the non-maximal TURBT group,including 30 males and 5 females,with an average age of(59.8±13.4)years.In the non-maximum TURBT group.The diameter of tumor was≥3 cm in 23 cases and<3 cm in 12 cases.There was no significant difference in preoperative data between the two groups(P>0.05).In the maximum TURBT group,all the tumors visible to the naked eye were completely removed,and the tissues were taken from the base and surrounding mucosa for pathological examination.Diagnostic TURBT group:multiple tumors in the bladder were found during the operation,the surface was rough,and there were no ureteral orifices on both sides.Samples of ureteral orifice and surrounding mucosal tissues were taken for biopsy,and the bladder tumor was not completely removed.Radical cystectomy was performed in both groups.The relationship between two different surgical methods and clinicopathological factors was analyzed.After that,the recurrence-free survival time(RFS)and overall survival time(OS)of patients were analyzed by Kaplan-Meier method,and the statistical difference of surviva

关 键 词：膀胱肿瘤 根治性膀胱切除术 预后 最大限度 经尿道膀胱肿瘤切除术 

分 类 号：R737.14[医药卫生—肿瘤]