高危非肌层浸润性膀胱癌二次经尿道电切治疗体会

Effect of repeat transurethral resection on high risk non-muscle invasive bladder cancer

目的探讨二次经尿道电切(repeat transurethral resection,ReTUR)在高危非肌层侵润性膀胱癌治疗中的效果及意义。方法我院自2005年5月—2010年5月期间治疗高危非肌层侵润性膀胱癌患者45例(男性24例,女性21例,年龄37～84岁,平均56.7岁),肿瘤直径0.3～4.0 cm,数目1～6枚,术后常规吡柔比星膀胱灌注化疗。4周后入院行ReTUR。结果本组患者ReTUR术后病理显示35.69%(16/45)有肿瘤残留,其中Ta期2例,Tl期12例,T2期2例。4例(8.7%)患者在初次电切术时低估肿瘤分期,2例患者因此更改治疗方案。ReTUR术中膀胱穿孔1例,保守治疗自愈。结论高危膀胱肿瘤残留率高,应常规行ReTUR,能提高分期的准确性,优化治疗方案,改善患者预后。

Objective To study the effects and implications of repeat transurethral resection（ReTUR） on high-risk non-muscle invasive bladder cancer.Methods From May 2005 to May 2010,a total of 45 cases with high-risk superficial bladder cancer were enrolled.There were 24 males and 21 females aging from 37 to 84 years（an average of 56.7 years old）,whose tumor size was from 0.3 to 4.0 cm and the number of tumor from 1 to 6.Pirarubicin were administered to all the patients＇ bladder after initial resection.ReTUR was performed after 4 weeks.Results 35.69%（16/45） had residual tumor including 2 of Ta,12 of T1 and 2 of T2.Four cases（8.7%） were understaged at initial resection;therefore,2 patients changed the treatment.One case had bladder perforation during repeat transurethral resection,which was spontaneously cured after the expectant treatment.Conclusion High-risk non-muscle invasive bladder cancer has a high rate of cancer residual after initial resection.Routine ReTUR is helpful to the precise pathological staging of cancer and the improvement of the prognosis.