二次电切在降低非肌层浸润性膀胱癌初次电切术后复发率中的临床价值  

Efficacy of repeat transurethral resection in the treatment of non-muscle invasive bladder cancer

作　　者：江东[1] 周益红 麦蕾[2] 吴振杰 洗建忠 戴英波 Jiang Dong;Zhou Yihong;Mai Lei;Wu Zhenjie;Xian Jianzhong;Dai Yingbo(Department of Urology,the Fifth Afiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China;Department of Gastroenterology,the Fifth Afiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China;Department of Ultrasound,the Fifth Afiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China)

机构地区：[1]中山大学附属第五医院医院泌尿外科,珠海519000 [2]中山大学附属第五医院医院消化内科,珠海519000 [3]中山大学附属第五医院医院超声科,珠海519000

出　　处：《中华腔镜泌尿外科杂志（电子版）》2022年第6期513-517,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：珠海市科技计划项目(20181117A010033);珠海市科技计划项目(20181117E030025)。

摘　　要：目的探讨经尿道膀胱肿瘤二次电切术(Re-TURBT)在降低T和T,期非肌层浸润性膀胱癌(NMIBC)电切术后肿瘤复发率的临床价值。方法回顾性分析2015年2月至2018年11月我院86例诊断为T_(a)和T_(1)期的NMIBC患者。患者接受单次经尿道膀胱肿瘤电切术为对照组(40例),接受二次经尿道膀胱肿瘤切除术为观察组(46例),两组患者首次电切术中均联合了吉西他滨即刻膀胱灌注化疗。统计观察组二次电切的阳性率及肿瘤分期分级变化情况,同时比较两组患者术后2年内的肿瘤复发及进展情况。结果两组患者年龄、性别、吸烟史、肿瘤最大径、肿瘤个数、首次电切病理分期比较差异无统计学意义(P>0.05)。观察组二次电切术后的病理结果显示,11例(23.91%)检出残余癌,5例出现临床分期升级,4例病理分级升级。观察组术后2年总复发率低于对照组(P<0.05)。两组术后2年总进展率差异无统计学意义(P>0.05)。结论Re-TURBT可明显降低T_(a)和T_(1)期NMIBC电切术后肿瘤复发率,同时可获得更准确的肿瘤分期,具有一定的临床价值。Objective To analyze the clinical effect of repeat transurethral resection of bladder tumor(Re-TURBT)in the treatment of T_(a) and T_(1),stage non-muscle invasive bladder cancer(NMIBC).MethodsThe clinical data of 86 patients with Ta and T,stage non-muscle invasive bladder cancer diagnosed in the Fifth Affiliated Hospital of Sun Yat-sen University from Feb.2015 to Nov.2018 were retrospectivley analysed.Forty patients received only TURBT were as control group,and 46 patients who underwent Re-TURBT were as observation group.All patients were treated with immediate intravesical instillation with gemcitabine.The positive rate of Re-TURBT and the change of tumor stage and grade were counted,and the tumor recurrence rate and progression rate were analyzed in two groups within 2 years after surgery.ResultsThe differences of age,gender,smoking history,maximum tumor size,number of tumors and first postoperative pathology were not statistically difference between the two groups(P>0.05).In observation group,the second postoperative pathological results showed that 11 cases(23.91%)of residual cancers were detected and there were clinical staging upgrades in 5 cases and pathological grading upgrades in 4 cases after surgery.The total recurrence rate of 2 years after surgery was lower than that of the control group(P<0.05).No significant dfference in total progress rate in 2 years after surgery(P>0.05).ConclusionsRe-TURBT combined with gemcitabine immediate intravesical instillation can reduce the tumor recurrence and obtain more accurate tumor stage of T_(a),and T_(1),stage NMIBC,which is of importantclinical value.

关 键 词：膀胱肿瘤 吉西他滨 膀胱电切术 

分 类 号：R737.14[医药卫生—肿瘤]