膀胱癌膀胱全切术后尿道复发的危险因素分析及干预研究

Analysis of the risk factors and intervention measure of urethral recurrence for bladder cancer with after radical cystectomy

目的对膀胱癌膀胱全切术(RC)后尿道复发(UR)的危险因素进行分析,并提出合理的干预措施。方法对2008年12月至2011年12月于武警陕西总队医院接受RC手术的280例膀胱癌患者的病历资料进行回顾性分析,根据是否发生UR,将患者分为UR组和非UR组,对UR发生的危险因素进行单因素分析和多因素Logistic回归分析,并据此提出相应的有效干预措施。结果 280例接受RC术的膀胱癌患者共有22例发生UR,UR发生率为7.9%;将这22例视为UR组,另外258作为非UR组,单因素分析显示,两组原发肿瘤大小、数量、复发与否、肿瘤部位、临床分期和病理分级的差异具有统计学意义(P<0.05),进一步对上述因素进行多因素Logistic回归分析显示,肿瘤大小、复发与否、肿瘤部位、临床分期和病理分级是UR发生的独立危险因素。结论膀胱癌患者RC术后UR的发生与患者肿瘤大小、复发与否、肿瘤部位、临床分期和病理分级密切相关;医师应该依据患者的危险因素决定是否同时行尿道切除术,同时术后密切随访,保障手术疗效,提升患者的生存质量。

Objective To analysis the risk factors of urethral recurrence（UR） for bladder cancer （BC） with after radical cystectomy （RC）, and to provide a reference for the prevention for UR. Methods Medical records of 280 BC patients accepted RC surgery from December 2008 to December 2011 in our hospital were retrospectively analyzed, according to whether UR occurs, the patients were divided into UR groups and non-UR group occurred, univariate analysis as well as multivariate logistic regression analysis were use for risk factors on the UR were carried out, and put forward corresponding effective interventions. Results A total of 22 patients in 280 BC cases accepted RC surgery were detected with UR, UR incidence was 7.9%;these 22 cases considered as UR group, other 258 cases were considered as the non-UR group, univariate analysis showed that the difference of the primary tumor size, number of recurrence or not, tumor location, clinical stage and histological grade in the two groups was statistically significant （P＆lt;0.05）;the above factors were further multivariate regression analyzed and showed that the tumor size, recurrence or not, tumor location, clinical stage and pathological graded were the independent risk factors for UR occur. Conclusion The occurrence of UR for BC patients after RC surgery is closely related to tumor size, recurrence or not, tumor location, clinical stage and pathological graded;physicians should decide whether to carry out urethral resection at the same time according to risk factors, closely follow-up patients after surgery, thus to protect the effect of surgery to improve the patients’ life quality.