“超声膀胱软镜”可辅助用于初发膀胱肿瘤术前分期诊断

"Flexible ultrasonic cystoscopy" can be used for preoperative staging of primary bladder cancer:an initial experience

目的采用超声支气管镜作为"超声膀胱软镜"进行膀胱肿瘤分期诊断,探讨其可行性及临床应用价值。方法对2010年6月至2010年11月我院收治的36例初发膀胱尿路上皮肿瘤患者术前行"超声膀胱软镜"检查以判断分期。"超声膀胱软镜"镜检后行常规膀胱镜检及活检术,所有患者均行静脉肾盂造影及盆腔CT检查,对于无法确诊肌层浸润的膀胱癌患者行经尿道膀胱肿瘤切除术(TURBT),并取肿瘤基底送病理。超声内镜检查结果与传统影像学检查结果及术后病理进行对照分析,比较超声内镜检查及常规膀胱镜检时患者的视觉疼痛评分(VAS)。结果 "超声膀胱软镜"检查术中VAS明显低于常规膀胱镜检(1.3±0.5 vs 4.3±0.9,P<0.01)。36例初发膀胱尿路上皮肿瘤患者经"超声膀胱软镜"诊断为非肌层浸润性膀胱癌(non-muscle-invasive bladder tumor,NMIBT;Ta+T1)28例,肌层浸润性膀胱癌(muscle-invasive bladder tumor,MIBT;T2+T3)8例。与术后病理分期相比,"超声膀胱软镜"诊断NMIBT与MIBT符合率均为100%。结论 "超声膀胱软镜"检查操作可行,痛苦小,能显示肿瘤浸润膀胱壁的深度,可辅助用于初发膀胱肿瘤术前分期诊断。

Objective To access the feasibility of using ＂flexible ultrasonic cystoscopy （FUCS）＂ （ultrasonic bronchoscope Olympus BF-UC260F-OL8 as a substitute） for staging of bladder cancer. Methods From Jun. 2010 to Nov. 2010,36 patiems with primary bladder urothelial carcinoma were examined by ＂FUCS＂ before operation and were staged by ＂FUCS＂ findings. All patients received IVP and enhanced pelvic CT. Non-muscle-invasive bladder cancer patients received TURBT, and the tumor base was routinely biopsied for pathology. Pathological results, traditional imaging evaluation, and ＂FUCS＂ evaluation were compared. Visual analog scores （VAS） were also compared between patients receiving ＂FUCS＂ and routine cystoscopy. Results Compared with conventional cystoscopy, the VAS of patients receiving intraoperative ＂FUCS＂ was significantly lower （1.3±0.5 vs 4.3 ±0.9, P〈0.01）. Of the 36 patients,28 were diagnosed as non-muscle-invasive bladder cancer （Ta ＋T1 ） and 8 were diagnosed as muscle-invasive bladder cancer （T2＋T3）. Based on the postoperative pathologic results,＂FUCS＂ had a 100% accuracy in diagnosing non-muscle-invasive and muscle- invasive bladder cancer. Conclusion ＂FUCS＂ is painless and feasible in clinical practice; it can display the depth of bladder wall invaded by tumor, and can be used for preoperative staging of primary bladder tumor.