39例浅表性膀胱肿瘤的第2次电切的临床价值

Second Transurethral Resection for Superficial Bladder Cancer

目的评估第2次电切对浅表性膀胱肿瘤的价值。方法回顾性分析了淮南市新华医院自2005年起对39例初发的浅表性膀胱肿瘤进行了第2次电切的患者的临床资料。所有患者在术后6h内均应用丝裂霉素20mg膀胱内灌注化疗。以后每周1次采用相同药物和剂量行膀胱内灌注直至术后4周再次入院进行第2次TUR。第2次TUR的范围包括第1次TUR以及其边缘1cm,同时行基底部和可疑膀胱黏膜处活检。进而分析第2次电切的病理标本。结果第2次TUR标本中共有5例(12.8%)患者病理证实有残存肿瘤存在;第2次TUR术后标本提示为肌层浸润性肿瘤2例。而且G3患者残存肿瘤阳性率高达50%。T1患者中也有第2次TUR阳性率增加的趋势。结论虽然第2次电切发现肿瘤残存阳性率并不高,而且只改变了少数患者的治疗计划,笔者仍然推荐对于高危险性浅表性膀胱肿瘤患者进行第2次电切,尤其是对于G3的患者。

Objective To evaluate the potential benefit of a second transurethral resectionfor the superficial bladder cancer. Methods A second transurethral resection was performed in 39 patients with newly diagnosed superficial bladder cancer since 2005 in our department. All the patients had immediate intravesical treatment with 20 mg Mitomycin after initial TURBt. Then all of them had weekly the same treatment until 4 weeks after the first TUR operation. The second transurethral resection was per- formed after 4 weeks of the first transurethral resection. The surgical sites from the second resection included original surgical area plus 1 cm margin. We also had biopsies at the baseline and suspected bladder mucosa. We reviewed all the pathological findings. Results Of the 39 patients who underwent second transurethral resection,5 cases（ 12.8% ） had residual cancer. 2 of 5 patients had a higher stage after the second transurethral resection. 50% of G3 tumors had a positive second transurethral resection. Also, there were more likely higher positive findings of T1 tumors in second transurethral resection. Conclusion Although second transurethral resection dramatically changed the treatment strategy in a small percentage of cases,we strongly recommend performing second transurethral resection in high risk superficial bladder cancer, especially in G3 tumors.