二次电切在治疗非肌层浸润膀胱癌临床意义

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (658 KB)
输出: BibTeX | EndNote (RIS)

摘要目的:比较常规经尿道膀胱肿瘤电切(TURBT)与经尿道膀胱肿瘤二次电切(Re-TURBT) 两种不同手术方式治疗非肌层浸润性膀胱癌临床效果,研究影响二次电切肿瘤阳性率相关危险因素。方法:回顾性研究2007年1月~2012年12月在广西医科大学第一附属医院泌尿外科病区及肾移植科病区接受手术治疗并确诊为非肌层浸润性膀胱癌201例患者资料,按照是否行Re-TURBT 分为2个研究组:常规行TURBT 169例及行Re-TURBT 32例。比较两组术后复发率、手术时间、术后住院天数、留置尿管天数况,分析其影响二次电切肿瘤阳性率的危险因素。结果:两种手术方式术后复发率差异有统计学意义(χ²=3.918,P＜0.05) 认为两种手术方式术后复发率有差别,二次电切术后复发率少于常规电切组,而两组手术时间(t=-0.195,P=0.846)、住院时间(t=1.423,P=0.156)、留置尿管天数(t=-0.466,P=0.642),均提示差异无统计学意义。根据logistic binary回归分析提示:首次电切时肿瘤为≥T₁(χ²=4.891,P=0.04)、高级别肿瘤(G₂及G₃)(χ²=1.903,P=0.001)、肿瘤大小≥3 cm(χ²=9.718,P=0.004)、多发肿瘤(≥3个)(χ²=6.203,P=0.02)均为二次电切阳性的独立危险因素,线性回归分析提示:首次电切肿瘤的病理级别对二次电切肿瘤阳性率影响最大。结论:Re-TURBT具有操作简单、手术安全性好、住院时间短、有效降低手术复发率等特点,对于首次电切为多发肿瘤、肿瘤较大(≥3 cm)、高级别肿瘤及高分期肿瘤(≥T₁期)等,尤其首次电切肿瘤为高级别肿瘤应常规行Re-TURBT。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	金宏
	黎承杨
	王翔
	陶芝伟
	周立权
	汪小明
	杨占斌
	邓耀良

关键词 ：膀胱肿瘤, 经尿道膀胱肿瘤电切术, 二次电切

Abstract：Objective: To investigate the clinical efficacy of the first transurethral resection of bladder tumor (TURBT) vs. repeated TURBT (Re-TURBT) in the treatment of non-muscle invasive bladder cancer and study the associated risk factors influencing the tumor positive rate of Re-TURBT. Methods: The clinical data of 201 cases of non-muscle invasive bladder cancer undergoing surgical treatments in our hospital from July 2007 to December 2012 were retrospectively analyzed, and divided into two groups: 169 patients undergoing conventional TURBT and 32 cases undergoing Re-TURBT. Postoperative recurrence rate, operation time, postoperative hospital stay, and indwelling catheter time were compared between two groups. The associated risk factors influencing tumor positive rate of Re-TURBT were analyzed. Results: There was significant difference in postoperative recurrence rate between two groups (χ²=3.918, P＜0.05). There was no significant difference in operation time (t=-0.195, P=0.846), hospital stay (t=1.423, P=0.156), and indwelling catheter time (t=-0.466, P=0.642) between two groups. The logistic binary regression analysis showed the first TURBTfor ≥ T₁ (χ²=4.891, P=0.04), high grade tumors (G₂ and G₃) (χ²=1.903, P=0.001), tumor size more than 3 cm (χ²=9.718, P=0.004), and multiple tumors (≥ 2) (χ²=6.203, P=0.02) were independent risk factors of positive rate of Re-TURBT. The pathological grade of the first TURBT had a great contribution to the regression equation. Conclusions: Re-TURBT has the advantages of simple operation, safety in operation, short hospitalization time, reducd postoperative recurrence rate, with regard to the first TURBT for multiple tumors, larger tumors (≥3 cm), high grade tumors and high stage tumors (≥T₁) etc, especially the first TURBT for high grade tumor, Re-TURBT is given regularly.

Key words： tumors of the bladder transurethral resection of bladder tumor repeated transurethral resection of the bladder tumor positive rate of tumor resection

收稿日期: 2015-04-15

ZTFLH:

R737.14

通讯作者: 邓耀良 E-mail: dylkf317@163.com

引用本文:

金宏,黎承杨,王翔,陶芝伟,周立权,汪小明,杨占斌,邓耀良. 二次电切在治疗非肌层浸润膀胱癌临床意义[J]. 微创泌尿外科杂志, 2015, 4(3): 150-154.
Kim Hong, Li Chengyang, Wang Xiang, Tao Zhiwei,Zhou Liquan, Wang Xiaoming, Yang Zhanbin, Deng Yaoliang. Repeated transurethral resection of bladder tumor for non-muscle invasive bladder cancer. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2015, 4(3): 150-154.

链接本文:

http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract776.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2015/V4/I3/150

[1]陈孝平,石应康. 外科学.2版.北京:人民卫生出版社,2010.
[2]陈梓甫.表浅膀胱癌的诊断与治疗.临床泌尿外科杂志,2003,18(5):257.
[3]Soloway MS. The management of superficial bladder cancer. Cancer, 1980,45(7):1856-1865
[4]Babjuk M, Oosterlinck W, Sylvester R, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder. Eur Urol, 2008, 54(2):303-314.
[5]Herr HW. The value of a second transurethral resection in evaluating patients with bladder tumors. J Urol, 1999,162(1):74-76.
[6]Divrik RT, Yildirim U, Zorlu F, et al. Is a second transurethral resection necessary for newly diagnosed pT1 bladder cancer? J Urol, 2006,175(4):1258-1261.
[7]Schwaibold HE, Sivalingam S, May F, et al. The value of a second transurethral resection for T1 bladder cancer. BJU Int, 2006,97(6):1199-1201.
[8]Miladi M, Peyromaure M, Zerbib M. The value of a second transurethral resection in evaluating patients with bladder tumours. Eur Urol, 2003,43(3): 241-245.
[9]Amling C, Thraser J, Frazier H, et al. Radical cystectomy for stages Ta, Tis, and T1 transitional cell carcinoma of the bladder. J Urol, 1994,151(1):31-35.
[10]Orsola A, Cecchini L, Raventós CX, et al. Risk factors for positive findings in patients with high-grade T1 bladder cancer treated with transurethral resection of bladder tumour (TUR) and bacille Calmette-Guérin therapy and the decision for a repeat TUR. BJU Int, 2010,105(2): 202-207.
[11]Sivalingam S, Probert JL, Schwaibold H. The role of repeat transurethral resection in the management of high-risk superficial transitional cell bladder cancer. BJU Int, 2005,96(6):759-762.
[12]Brauers A, Buettner R, Jakse G. Second resection and prognosis of primary high risk superficial bladder cancer: is cystectomy often too early? J Urol, 2001,165(3):808-810.
[13]Brausi M, Collette L, Kurth K, et al. Variability in the recurence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cel carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur Urol, 2002,41(5):523-531.
[14]Mersdorf A, Brauers A, Wolff JM, et al. Second trunsuerthal resection for superficial bladder cancer. Urology, 1998,159(suppl):143.
[15]Klan R, Loy V, Huland H. Residual tumors discoveerd in routine second trunsuerthal resection in patients with stage T1 trunsuerthal cell carcinoma of the bladder. Uorlogy, 1991,146(2):316-318.