电子膀胱软镜下膀胱肿瘤整块切除术联合辅助治疗对T_(2)期膀胱癌保膀胱综合治疗的可行性  

Feasibility study of transurethral en-bloc resection of bladder tumor under electronic flexible cystoscopy combined with adjuvant therapy for bladder-preservation-therapy in T_(2)stage bladder cancer

作　　者：王琦[1] 于洪亮 王毅[1] 王进有[1] 杨超[1] 陈新 刘志奇 孙伟 方露[1] 于德新[1] 闵捷[1] Wang Qi;Yu Hongliang;Wang Yi;Wang Jinyou;Yang Chao;Chen Xin;Liu Zhiqi;Sun Wei;Fang Lu;Yu Dexin;Min Jie(Department of Urology,The Second Hospital of Anhui Medical University,Hefei 230601,China;Department of Urology,Shannan People's Hospital of The Tibet Autonomous Region,Shannan 856000,China)

机构地区：[1]安徽医科大学第二附属医院泌尿外科,合肥230601 [2]西藏自治区山南市人民医院泌尿外科,山南856000

出　　处：《中华泌尿外科杂志》2023年第12期901-905,共5页Chinese Journal of Urology

基　　金：安徽省高校科学研究项目(KJ2021A0312);安徽省转化医学研究院科研基金培育项目(2021zhyx-C62)。

摘　　要：目的探讨窄光谱成像(NBI)电子膀胱软镜下膀胱肿瘤整块切除术(ERBT)+术后免疫联合化疗治疗T,期膀胱癌的可行性。方法回顾性分析2019年3月至2022年1月安徽医科大学第二附属医院收治的16例pT_(2)N_(0)M_(0)期膀胱癌患者的临床资料。患者均为男性,中位年龄63(56,73)岁。既往有吸烟史9例,合并高血压病5例、糖尿病3例、心脏病2例。美国麻醉医师协会分级≤Ⅰ级12例,Ⅱ级4例。术前组织活检结果均为尿路上皮癌。全麻,患者取截石位,均接受NBI电子膀胱软镜下ERBT。术中电子膀胱软镜在NBI模式下可见肿瘤呈棕色,周围正常黏膜呈青色。以激光距肿瘤基底边缘约1.0cm处开始刻除,刻除深度达肌层外浆膜(蜂窝脂肪组织),整块切除肿瘤,使用一次性内镜网篮取出标本后标记基底部送病理检查。术后1周,病理检查证实肿瘤分期为T,期。开始替雷利珠单抗联合吉西他滨+顺铂(GC)方案治疗4个周期,然后所有患者均行二次ERBT,电切部位包括首次手术瘢痕处和其他可疑占位。记录两次手术的时间、出血量、并发症等。记录病理完全缓解(pCR)率和病理降期率,随访肿瘤复发情况。结果本研究16例的两次手术均顺利完成。两次术中均无明显闭孔反射和出血,发生1级穿孔4例,无≥2级膀胱穿孔。术后30d内2例发生并发症,分别为血尿1例,膀胱刺激征1例。治疗结束后总pCR率和总病理降期率均为100%。中位随访13(6,36)个月,复发1例。结论NBI电子膀胱软镜下ERBT的操作视野清晰,膀胱穿孔和出血等并发症少。术后联合免疫+化疗方案对T_(2)期膀胱癌行保膀胱综合治疗的效果肯定,临床可行性较高。Objective To investigate the feasibility of combination of en-bloc resection of bladder tumor(ERBT)with the NBI(narrow band imaging)flexible cystoscopy,immunotherapy and chemotherapy in bladder-preserving treatments(called as TMT)for patients with stage T_(2) bladder carcinoma.Methods We retrospectively reviewed and analyzed a series of 16 patients with pT_(2)N_(0)M_(0) pathologically confirmed.All patients are male with a median age of 63yr(56,73yr).The American Association of Anesthesiologists scored≤Ⅱ in 12 cases and Ⅱ in 4 cases.There were 9 cases with smoking history,5 cases with hypertension,3 cases with diabetes,and 2 cases with heart disease.The results of preoperative tissue biopsy were all urothelial carcinoma.All patients were taken lithotomy position and performed ERBT with NBI imaging technique and thulium-laser energy platform under general anesthesia.The tumor was brown and the surrounding normal mucosa was cyan in color.The procedure was ensured with a minimal tumor margin of cm and minimal rection depth to the deep musculi,and with the acquirement for the en-bloc specimen of which the basal site was marked afterwards,the patients all took a full length of chemoimmunotherapy(four cycles of Tislelizumab combined with Gemcitabine and cisplatin regimens)followed by a secondary ERBT.The perioperative data from sequential operations including complications were comprehensively analyzed for evaluating the therapeutic outcome and safety.All patients received a follow-up to detect efficacy and safety of the treatment with the primary end point of pCR,downgrading rate and objective response rate.Results All operations were successfully completed.There was no obturator reflex,severe bleeding or grade I bladder perforation,only 4 patients got a grade I bladder perforation.The postoperative 30-day complication occured in 2 cases(1 pt with hematuresis,1 pt with bladder irritation).The pathologic complete response rate and tumor downstaging rate were 100%.One patient recurred during a median follow-up of

关 键 词：窄光谱成像电子膀胱软镜 经尿道膀胱肿瘤整块切除术 辅助治疗 保膀胱综合治疗 

分 类 号：R737.14[医药卫生—肿瘤]