晨起第一次新鲜中段尿用于膀胱癌细胞学诊断的临床价值

Application of fresh first morning midstream urine in cytological study of bladder cancer patients

目的 探讨晨起第一次中段尿脱落细胞学检查诊断膀胱癌的临床价值. 方法 分析52例经活检或手术病理确诊为膀胱癌患者晨起第一、二次新鲜中段尿脱落细胞学检查结果,以连续3 d标本结果和单次标本结果为研究对象,按总体、病理分级及临床分期分别计算2个时段尿脱落细胞阳性率,并进行统计学分析. 结果 52例患者晨起第一、二次新鲜中段尿脱落细胞学检查阳性率分别为78.8%（41/52）和80.8%（42/52）;156个标本晨起第一、二次尿阳性率分别为56.4%（88/156）和60.9%（95/156）.33例G1～Gz患者晨起第一、二次尿阳性率分别为69.7%（23/33）和72.7%（24/33）;99个标本晨起第一、二次尿阳性率分别为44.4%（44/99）和4 8.5%（48/99）.42例非肌层浸润性膀胱癌患者晨起第一、二次尿阳性率分别为73.8%（31/42）和76.2%（32/42）;126个标本晨起第一、二次尿阳性率分别为54.8%（69/126）和57.1%（72/126）.晨起第一、二次新鲜中段尿脱落细胞学检查诊断膀胱癌、低分级膀胱癌及非肌层浸润性膀胱癌的阳性率比较差异均无统计学意义（P＞0.05）.结论 晨起第一次新鲜中段尿可用为尿脱落细胞学检查诊断膀胱癌的尿液标本,对于低分期、低分级膀胱癌有不亚于晨起第二次新鲜中段尿的诊断价值.

Objective To investigate the value of the application of the fresh first morning midstream urine in cytological study of bladder cancer patients. Methods The results of the fresh first and second morning midstream urine cytological studies for 52 bladder cancer patients were analyzed.Continual three urine samples and single urine sample were treated as study objects respectively. The positive rates in different tumor stages and grades were evaluated. Results The positive rate of overall 52 patients was 78. 8 % （41/52） in fresh first morning midstream urine and 80. 8% （ 42 / 52） in the fresh second morning midstream urine. While in 156 single urine samples, the positive percentages were 56.4%（88/156） and 60. 9% （95/156）. The positive rates of the fresh first and second morning midstream urine were 69.7% （23/33） and 72.7% （24/33） respectively in grade 1- 2 patients, and 44.4 % （44/99） and 48. 5 % （48/99） in 99 single urine samples. The positive rates of 42 non-muscle invasive bladder cancer patients were 73. 8% （31/42） and 76.2% （32/42） in the fresh first and second morning midstream urine, while in 126 single urine samples, the positive rates were 54.8% （69/126）and 57.1% （72/126）. There were no significant differences between positive rate of the fresh first and second morning midstream urine in diagnosis of bladder cancer, low grade bladder cancer and nonmuscle invasive bladder cancer. Conclusion The fresh first morning midstream urine can be used for urine cytological study in the diagnosis of bladder cancer, even in the diagnosis of low stage and low grade bladder cancer.