5-氨基乙酰丙酸诱导荧光膀胱镜在膀胱肿瘤诊断中的应用(附31例报告)

5-Aminolevulinic Acid Induced Fluorescence Cystoscopy in Diagnosis of Bladder Cancer(Report of 31 Cases)

目的:研究5-氨基乙酰丙酸(5-ALA)诱导荧光光动力学对膀胱肿瘤的早期诊断价值。方法:对血尿患者行5-ALA诱导荧光膀胱镜检查及活组织检查,以5-ALA膀胱灌注,2 h后采用D-light光源系统进行膀胱镜检,对荧光阳性区域及白光下肉眼可见异常但荧光阴性区域进行活检,活检后行经尿道膀胱肿瘤电切术。结果:31例患者中有4例荧光阴性且普通光肉眼观阴性者未活检。余27例患者共取活检96处,其中荧光阳性区域取活检89处(包括普通光肉眼观阴性区域35处),切缘取活检7处。病理检查结果显示:尿路上皮癌65处,阳性率为73.03%(65/89),非肿瘤性病变24例,假阳性率为27%(24/89),切缘活检7处为阴性。荧光下阳性而白光下阴性的肿瘤位点11处,切缘活检7处均为阴性。结论:5-ALA诱导荧光光动力学诊断对膀胱肿瘤有较高价值,能发现早期肿瘤,同时进行电切将更彻底。

Objective：To assess the value of 5-aminolevulinic acid（5-ALA） induced fluorescence cystoscopy in the early diagnosis of bladder cancer. Methods：The study was conducted in 31 patients with hematuria who received 5-ALA intravesically before cystoscopy. 2 hours later, those patients underwent cystoscopy under visible white light and under fluorescent light （DLIGHT System）. Under white and fluorescence light guidance, tumor locations were recorded,biopsies were taken at the positive areas under fluorescence light and the positive areas under white light but non-fluorescent,then tumors were resected. Results： 4 cases were both negative under white and fluores cence light with no biopsy. A total of 96 biopsies were taken in 27 procedures of fluorescent and non-fluorescent areas,which included 89 fluorescence positive biopsies（35 biopsies were negative under white light） and 7 surgical margin biopsies. Among 89 biopsies 65 （73%） were proved to be urothelial carcinoma, 24 （27 %） were non-tumor lesions, l 1 biopsies were urothelial carcinoma which were negative under white light endoscopy. All 7 surgical margin biopsies were non tumor lesions. Conclusions：5 aminolevulinic acid induced fluorescence cystoscopy had proved to be a valuable method with high sensitivity for bladder cancer,which could detected early carcinoma decreased residual tumor rates.