手术方式对保留膀胱的膀胱移行细胞癌患者预后的影响

Effect of operative methods on the prognosis of bladder-preserving patients with bladder transitional cell carcinoma

目的:分析各种保留膀胱手术方式与膀胱移行细胞癌病人的肿瘤复发率、近远期存活率及首次复发时间之间的关系,探讨膀胱肿瘤保留膀胱的策略。方法:对我院近15年间收治的膀胱肿瘤病人进行资料收集并随访,采用寿命表法及q检验及卡方检验等统计学方法分析249例资料齐全的保留膀胱病人的复发率、复发时间和近远期存活率与手术方式的关系。结果:手术方式对膀胱肿瘤首次复发时间的影响不明显,三种手术方式后膀胱肿瘤的总复发率、3年和5年生存率无显著性差异,而10年生存率以经尿道膀胱肿瘤电切术为最高(77.3%),膀胱部分切除术最低(65.2%),差异有统计学意义。结论:经尿道膀胱肿瘤电切术可获得与开放性手术(膀胱肿瘤切除和膀胱部分切除术)同样的近期疗效,并有较高的远期存活率。

Objective：To investigate the correlation between overall recurrence rate, survival rate, and the first recurrence duration and operative methods, and to discuss the strategy of bladder-preserving for patients with bladder transitional cell carcinoma （TCC）.Methods：A total of 249 cases of bladder tumor with complete follow-up data,treated from 1991 to 2005 in our hospital, were studied re trospectively.The correlation between overall recurrence rate,survival rate and the first recurrence duration and operative methods were analyzed by the life table method,and statistical methods,like Newman-Keuls and chi-square test.Result：The first recurrence duration was not influenced by operative methods. There was no significant difference of overall recurrence rate and short-term survival rate （3-year and 5-year）among different operative metheds,the highest 10-year survival rate（77.3%）occurrad in the group of transurethral resection of bladder tumor（TURB）and the lowest one（65.2%）in the group of partial cystectomy,and the difference was statistically significant.Conclusions：TURB could achieve the same short-term therapeutic effect as opening operations（partial resection of bladder or resection of bladder tumors）and the higher long-term survival rate can be obtained by TURB.