膀胱出口不全梗阻与膀胱癌发病的相关性

Correlation between bladder outlet obstruction and bladder cancer

目的 探讨膀胱出口不全梗阻在膀胱癌发病和复发中的作用.方法 回顾性分析2001年1月至2008年11月我院收治的前列腺增生患者581例的临床资料,将其中接受手术治疗的39例随机分为同期经尿道等离子双极前列腺电切术（TUPKP）＋经尿道膀胱肿瘤电切术（TURBT）组（23例）及单纯行TURBT 组（16例）,对2组分别行TUPKP＋TURBT和TURBT,随访12～36个月,观察术后2组的膀胱癌复发率及复发时间,同时观察经耻骨上膀胱肿瘤切除术的患者膀胱颈口狭窄情况.观察2组术前国际前列腺症状评分（IPSS）,最大尿流率（Qmax）,残余尿量（RUV）,术后IPSS、Qmax、RUV及术后1年内膀胱肿瘤复发率.结果 TUPKP＋TURBT组术后IPSS、Qmax、RUV分别为（13±8）分、（19.3±9.5）ml/s、（18.7±11.6）ml,TURBT组分别为（20±7）分、（11.5±8.2）ml/s、（42.9±13.7）ml,2组相比差异有统计学意义（t值分别为3.013、15.190、4.532,P均〈0.05）.TUPKP＋TURBT组1年内膀胱癌复发率34.78%（8/23）明显低于TURBT组的68.75%（11/16）（χ^2 值为4.358,P〈0.05）.结论 膀胱出口不全梗阻与膀胱癌的发生发展和复发有着密切的关系,在行膀胱癌手术时,需考虑到同期解除前列腺增生或其他原因所致的膀胱出口不全梗阻.

Objective To investigate the role of the bladder outlet obstruction in the bladder cancer incidence and recurrence.Methods From Jan.2001 to Jan.2008 in our hospital,fourty-one cases of benign prostatic hyperplasia patients,with bladder cancer,were selected from 581 cases of benign prostatic hyperplasia patients,39 of them were randomly divided into two groups：One group were treated by surgery of bipolar transurethral plasma kinetic of prostatectomy（TUPKP） and transurethral resection of bladder tumor（TURBT） at the same time （observe group：23 cases）,and the other group were treated by surgery of TURBT（control group：16 cases）.All the patients were followed up for 12 to 36 months.Recurrence rate and recurrence time,as well as the suprapubic bladder tumor surgery in patients with stenosis of the bladder neck was also observed.Preoperative International Prostate Symptom Score （IPSS）,maximum flow rate （Qmax）,residual urine （RUV） and postoperative IPSS,Qmax,and RUV were tested for the difference between the two groups using t test.The variability of relapse rate after one year between the two groups were analyzed by χ~2 test.All statistical analysis was performed in SPSS 11.5.Results Postoperative IPSS,Qmax,RUV were （13±8）points,（19.3±9.5）ml/s,（18.7±11.6）ml in observe group and （20±7）points,（11.5±8.2）ml/s,（42.9±13.7）ml in control group （P〈0.05）,and the recurrence rate in 1 year was 34.78%（8/23） and 68.75% （11/16） in the two groups （P〈0.05）.Conclusions There is close correlation between bladder cancer and bladder outlet obstruction.The patients of bladder cancer combined with bladder outlet obstruction should be discharged bladder outlet obstruction at the same time.