二次经尿道膀胱肿瘤切除术在T1期膀胱癌治疗中的临床价值  

The clinical value of secondary electric resection in the treatment of T1 bladder cancer

作　　者：张城栋 段帅帅 赵英帅 辛士永[2] 任小强[2] 张建国[2] Zhang Chengdong;Duan Shuaishuai;Zhao Yingshuai;Xin Shiyong;Ren Xiaoqiang;Zhang Jianguo(College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471003,China;Department of Urology,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]河南科技大学临床医学院,洛阳471003 [2]河南科技大学第一附属医院开元院区泌尿外科,洛阳471003

出　　处：《国际泌尿系统杂志》2023年第4期609-613,共5页International Journal of Urology and Nephrology

摘　　要：目的探讨二次经尿道膀胱肿瘤切除术(re-TURBT)在T1期膀胱癌治疗中的临床价值。方法选取2016年1月至2017年10月河南科技大学第一附属医院收治的84例初次诊断为T1期膀胱癌的患者。根据患者是否愿意接受re-TURBT分为re-TURBT组(39例)和经尿道膀胱肿瘤电切术(TURBT)组(45例)。统计两组患者的年龄、性别、体重指数(BMI)、是否吸烟、饮酒、是否患高血压、肿瘤长径、部位及肿瘤是否单发、首次手术时留取标本是否包含肌层、首次肿瘤的临床分期及病理分级、肿瘤无复发生存期(RFS)、肿瘤无进展生存期(PFS)及re-TURBT组术后的临床分期和病理分级情况。结果两组的肿瘤复发率比较,差异有统计学意义(42.2%vs.35.9%,P<0.05)。logistic回归模型分析结果显示:首次电切肿瘤≥3 cm及肿瘤病理分级(高级别)是T1期膀胱癌再次电切阳性的独立危险因素(均P<0.05)。TURBT组患者的平均RFS短于re-TURBT组,差异有统计学意义(22.54个月vs.28.74个月,P=0.043),平均PFS短于re-TURBT组,但差异无统计学意义(25.85个月vs.27.14个月,P=0.319)。首次TURBT病理结果显示,2例升级为T2期,1例初次诊断为低级别尿路上皮癌上升至高级别尿路上皮癌。结论首次电切肿瘤长径≥3 cm、肿瘤分级(高级别)的T1期膀胱癌患者建议行re-TURBT治疗,可实现更完整的肿瘤切除以及降低患者的肿瘤复发率,同时获取更准确的肿瘤分期,具有重要的临床价值及意义。Objective To explore the clinical value of re-TURBT in the treatment of T1 bladder cancer.Methods The study was conducted on 84 cases whose initial diagnoses were T1 phase of bladder cancer in our hospital from January 2016 to October 2017.Patients were divided into TURBT group(45 cases)and re-TURBT group(39 cases)according to whether they were willing to undergo resection.The age,gender,BMI,whether smoking,drinking,hypertension,tumor size,location,and whether the tumor was single,whether the specimens collected during the first operation included muscle layer,the clinical stage and pathological grade of the first tumor,tumor recurrence-free survival(RFS),tumor progression-free survival(PFS),postoperative clinical stage and pathological grading of the re-TURBT group.Results There was a significant difference in the recurrence rate between the two groups(42.2%vs.35.9%,P<0.05).logistic regression model analysis showed that tumor≥3 cm after first resection and tumor pathological grade(high grade)were independent risk factors for positive re-resection of bladder tumor at T1 stage.The mean RFS of the TURBT group was significantly shorter than that of the re-TURBT group(22.54 months vs.28.74 months,P=0.043)and the mean PFS of the TURBT group was significantly shorter than that of the re-TURBT group(25.85 months vs.27.14 months,P=0.319).First TURBT pathology showed that 2 patients advanced to T2 stage in clinical staging.In terms of pathological grade,1 case was initially diagnosed with low-grade urothelial carcinoma and advanced to high-grade urothelial carcinoma.Conclusions Patients with stage T1 bladder cancer whose tumor size(≥3 cm)and tumor pathological grade(high grade)should be advised to perform conventional re-TURBT to achieve more complete tumor resection,reduce the recurrence rate of patients,and obtain more accurate tumor staging,which is important clinical value and significance.

关 键 词：膀胱肿瘤 膀胱切除术 复发 

分 类 号：R737.14[医药卫生—肿瘤]