摘要
目的探讨高级别非肌层浸润性膀胱癌（NMIBC）进行二次经尿道电切术（ReTUR）治疗的必要性。方法行经尿道膀胱肿瘤电切术（TUB-BT）后病理学检查证实为高级别NMIBC的患者64例,随机分入2组,每组32例。ReTUR组患者在首次TUB-BT后6周行ReTUR,对照组患者不行ReTUR,两组均行膀胱灌注化疗。分析ReTUR的病理学检查结果、肿瘤残留率、分期低估率,记录ReTUR住院天数、费用及并发症发生率。首次TUB-BT后每3个月随访时行膀胱镜检查1次。随访终点为膀胱癌复发、进展和患者死亡。结果 ReTUR组患者行ReTUR中,仅1例患者发现肿瘤残留,总阳性率为3.1%,且肿瘤分期由Ta期上升至T1期,分期低估率为3.1%。ReTUR组的并发症发生率为15.6%（5/32）。ReTUR组行ReTUR的平均住院天数为（5.2±1.3）d,术后平均住院天数为（3.4±1.1）d,平均住院费用为（6 752±764）元。对照组术后随访12~38个月,ReTUR组术后随访14~37个月,对照组和ReTUR组的肿瘤复发率分别为15.6%（5/32）、12.5%（4/32）,肿瘤进展率分别为6.2%（2/32）和3.1%（1/32）,均无死亡病例,两组间肿瘤复发率、进展率及患者病死率的差异均无统计学意义（P值均〉0.05）。结论高级别NMIBC在高质量、规范化、彻底的首次TUB-BT后,行辅助规范的膀胱灌注化疗,无需常规行ReTUR。
Objective To evaluate whether it is necessary to perform repeat transurethral resection（ReTUR）in high grade non-muscle-invasive bladder cancer.Methods Sixty-four newly diagnosed high grade non-muscle-invasive bladder cancer patients were randomized into two groups.There were 32patients in each group.ReTUR was performed within 6weeks after the initial resection in ReTUR group,while ReTUR was not done in control group.All patients received the instillation of intravesical chemotherapy within 24hafter the initial resection and every week later.Follow-up cystoscopy was performed at 3-month intervals.Residual tumor rate in ReTUR,recurrence,progression rate,hospital stay,cost and complications were recorded.Results Residual tumor was detected histopathologically and upper-stage in 1of 32patients（3.1%）in ReTUR group.In ReTUR group,the incidence of complications was 15.6%（5/32）,average hospital stay for surgery was（5.2±1.3）d,postoperative hospital stay was（3.4±1.1）d,and cost for ReTUR was（6 752±764）yuan.The follow-up period was 12—38months in control group and 14—37months in ReTUR group.Recurrence rate was 15.6%（5/32）in control group and 12.5%（4/32）in ReTUR group.Tumor progression was observed in 2patients for control group and 1patient in ReTUR group.There was no significant difference between groups in recurrence rate or progression rate（P0.05）.No patients died at the final follow-up.Conclusion Routine ReTUR is not necessary for all high grade non-muscle-invasive bladder cancer after high quality,complete,adequate,standard initial transurethral resection and the instillation of intravesical chemotherapy.（Shanghai Med J,2013,36：587-591）
出处
《上海医学》
CAS
CSCD
北大核心
2013年第7期587-591,共5页
Shanghai Medical Journal
关键词
膀胱癌
二次经尿道电切
高级别
Bladder cancer
Second transurethral resection
High grade
