二次电切在非肌层浸润性膀胱癌中应用的肿瘤学价值  

Oncology Evaluation of Second TURBT in Non-muscle Invasive Bladder Cancer

作　　者：魏希锋[1] 陈超[1] 卞超杰 张淼[2] 马立旭[3] 高平生[1] WEI Xifeng;CHEN Chao;BIAN Chaojie(Department of Urology,People’s Hospital of Ningxia Hui Autonomous Region,Yinchuan City,Ningxia 750002;不详)

机构地区：[1]宁夏回族自治区人民医院泌尿外科,宁夏银川市750002 [2]宁夏回族自治区人民医院病理科,宁夏银川市750002 [3]宁夏回族自治区人民医院病案统计科,宁夏银川市750002

出　　处：《医学理论与实践》2022年第12期2002-2004,2011,共4页The Journal of Medical Theory and Practice

基　　金：中央高校基本科研业务费资助项目(31920160104);宁夏重点研发计划项目(2019BEG03057)。

摘　　要：目的:探讨经尿道膀胱肿瘤二次电切(second TURBT)治疗非肌层浸润性膀胱癌(NMIBC)的临床应用效果,指导二次电切的规范开展。方法:回顾性分析2016年1月—2019年12月在我院泌尿外科首次行尿道膀胱肿瘤电切术(TURBT)治疗并病理诊断为NMIBC的79例患者临床资料,其中行二次TURBT的患者35例为观察组,行常规TURBT的患者44例为对照组。术后行经膀胱盐酸吡柔比星灌注化疗,术后3、6、12、24个月复查泌尿系彩超、膀胱镜检查。分析观察组残余肿瘤、逼尿肌、分期升高,比较两组患者的临床特征,复发率、临床进展情况,并记录研究过程中的不良事件。结果:观察组首次电切后17例(48.6%)基底无肌层组织,二次电切后13例(37.1%)有残余肿瘤,5例(14.3%)有肿瘤分期升高,其中4例改行膀胱根治性切除术。随访6~24个月(平均20个月),观察组有8例(22.9%)肿瘤复发,对照组20例(45.5%)肿瘤复发。两组患者围手术期无大出血、膀胱穿孔发生。至随访结束分析,两组间1年内复发率、总复发率差异有统计学意义(P<0.05),两组患者临床特征及疾病进展情况均无统计学差异(P>0.05)。结论:二次电切可切除残存肿瘤,更准确了解肿瘤分期情况,且可以有效降低患者复发率,对于指导患者诊治方案具有重要意义,可在把握适应证的情况下在临床推广应用。Objective:To investigate the clinical efficacy of second transurethral resection of bladder tumors(second TURBT)in the treatment of non-muscle invasive bladder cancer(NMIBC),and to guide the standard development of second TURBT.Methods:Retrospective analysis was performed on the clinical data of 79 patients who received the first TURBT treatment and were pathologically diagnosed as NMIBC in the department of urology of our hospital from January 2016 to December 2019.Among them,35 patients who received second TURBT treatment were included in the observation group,and 44 patients who received conventional TURBT were included in the control group.Perfusion chemotherapy of pirubicin hydrochloride was performed regularly after surgery.Urological ultrasonography and cystoscopy were examined 3,6,12 and 24 months after surgery.The residual tumor,detrusor muscle and stage increase were observed in observation group,and the clinical features,recurrence rate and clinical progress of the two groups were compared,and adverse events during the study were recorded.Results:In the observation group,17 cases(48.6%)had no muscularis tissue in the base after the first TURBT.13 cases(37.1%)with residual tumor and 5 cases(14.3%)with increased tumor stage were found in the observation group after the second TURBT,and 4 cases underwent radical cystectomy.Follow-up period ranged from 6 to 24 months(mean 20 months).Tumor recurrence occurred in 8 patients(22.9%)of the observation group and 20 patients(45.5%)of the control group.There was on major bleeding and bladder perforation in two groups during perioperative period.At the end of follow-up,there was statistically significant differences in the recurrence rate and total recurrence rate within 1 year between the two groups(P<0.05),while there was no statistically significant differences in clinical characteristics and disease progression between the two groups(P>0.05).Conclusion:Second TURBT can remove residual tumors,more accurately understand the tumor stage,and effectively reduce the

关 键 词：非肌层浸润性膀胱癌 经尿道膀胱肿瘤电切术 二次电切 

分 类 号：R737.14[医药卫生—肿瘤]