膀胱内灌注ALA光动力学技术早期诊断和治疗膀胱乳头状癌的初步体会

Photodynamic Diagnosis and Resection Bladder Cancer following Intravasical Instillation of 5-aminolevulinic Acid

为了研究以5-氨基果糖酸(ALA)作为荧光物质的光动力学诊断系统(PDD)对膀胱微小乳头状癌、上皮的不典型增生和原位癌诊断的敏感性和特异性,对12例临床诊断为膀胱癌的患者,于术前用ALA1.5克+8.4％NaHCO_3 50ml行膀胱内灌注,2～4小时后进行常规膀胱镜检和荧光膀胱镜检(光源为λ=375～440nm蓝光),然后在有荧光部位行活检送病理检查。12例共69个活检标本,病理结果显示PDD对膀胱癌及不典型增生的诊断敏感性为100％,特异性为86.7％,假阳性率为13.3％,无假阴性。荧光膀胱镜检可以发现常规膀胱镜检难以发现的微小癌灶及不典型增生,指导电切,对减少肿瘤的遗漏和降低复发率有较大的临床意义。

To study the sensitivity and specificity of detection early bladder cancer or dysplasia with fluorescence cystoscopy following intravasical instillation of 5-aminol evulinic acid (ALA ), 1.5 gram ALA hy-drochloride dissolved in 50ml 8. 4% sodium bicarbonate was instilled intravesically in 12 patients with a suspicion of primary bladder cancer. Cystoscopy under white light arc, violet light(= 375~440nm) were performed in this patients. The violet light from a xenon arclamp with a band pass filter system, was used for intravesical induction of fluorescence. Biopsies were obstained from fluorescent areas of the bladder. A total of 69 biopsies was obstained. The histological results showed the sensitivity of the fluorescence cystoscopy was 100%, the specificity was 86. 7 %, the false positive was 13.3%, and no false negative. The fluorescence cystoscopy might help to find the tiny malignant lesions that are difficult to visualize with standard cystoscopy, and help to completly resecte the urethelial neoplasms, and decrease the recurrent rate.