非肌层浸润性膀胱癌患者行二次经尿道膀胱肿瘤电切治疗的临床研究

Clinical research on second electric transurethral resection for noninvasive bladder cancer

目的探讨非肌层浸润性膀胱癌行第二次经尿道膀胱肿瘤电切术（TURBt）治疗的临床意义。方法对94例（观察组）初次行TURBt治疗后诊断为非肌层浸润性膀胱癌患者行第二次TURBt治疗，观察残余肿瘤存在与否及位置，肿瘤病理分期、分级的变化，根据第二次TURBt的结果采取的不同治疗方案。以同期单次行TURBt治疗的42例患者为对照。结果观察组49例（52％）发现有残余肿瘤，15例（16％）有肿瘤分期或分级的升高，根据二次TURBt结果，有15例患者改变了治疗方案。随访18～36个月（平均24个月），观察组5例（5％）肿瘤复发，对照组9例（21％）肿瘤复发。结论第二次TURBt治疗是揭示肿瘤实际情况、评估分期、检测残存肿瘤的有效方法，特别是对于高分级、肿瘤较大和肿瘤多发者具有更重要的意义，同时可明显降低肿瘤的复发与进展。

Objective To explore clinical significance in the second electric transurethral resection for noninvasive bladder cancer （TURBt）. Methods Ninety-four patients with diagnosed noninvasive bladder cancer in the observed group were undergone the second TURBt after primary one to observe the existence of tumor residue and its location, and changes in its pathological stage and grade, with forty-two noninvasive bladder cancer patients by single TURBt and partial cystectomy or radical total cystectomy as controls. Different treatment plans were instituted according to their outcomes of the second TURBt. Results Tumor residues were found in 49 patients （52%） with the second TURBt and pathological stage and grade were found increased in 15 patients. Treatment plans were changed for 15 patients according to their outcomes of the second TURBt. Tumor recurred in five patients in the observed group and nine in the control group after follow-up for 18 to 36 months （24 months in average）. Conclusions The second TURBt is an only effective method to treat for patients with noninvasive bladder cancer to reveal their actual situation, evaluate their stages and examine residue of the tumor, especially more importance for those patients with later stages, larger size and multiple occurrence of the tumor, which can decline its recurrence and postpone its progression.