剥脱式经尿道膀胱肿瘤切除术

Exfoliative transurethral resection of bladder tumor

目的探讨剥脱式经尿道膀胱肿瘤切除术(E-TURBT)切除非肌层浸润性膀胱肿瘤的安全有效性。方法从2000年12月到2011年12月,114例非肌层浸润性膀胱肿瘤患者由同一名泌尿外科医师采用E-TURBT治疗136次,术后随访(4.82±4.1)年,观察手术的治疗效果及并发症。结果在114例患者中,第一次E-TURBT治疗后96例(84.21%)未复发,18例(15.79%)复发。复发的18例患者,行第二次E-TURBT治疗后13例(72.2%)未复发,5例(27.8%)第二次复发。第二次复发的5例患者2例(40%)行第三次E-TURBT治疗后未复发,另外2例(40%)患者在第三次复发时发现远处转移,仅有1例(20%)患者第三次复发后拒绝进一步治疗。随访期间所有患者未发生膀胱穿孔或中转开放手术,仅有2例患者临床分期升高(2/114,1.75%),111例患者无瘤生存,总有效率达97.37%(111/114)。结论 E-TURBT是TURBT改良的手术方式,能够更加有效地切除肿瘤、避免肿瘤残余,降低复发率,是治疗非肌层浸润性膀胱肿瘤有效、安全、简捷、易操作的手术方式。

Objective To present a new technique of transurethral resection of bladder tumor （TURBT）, which is called exfoliative transurethral resection of bladder tumor （E-TURBT）. Methods From December 2000 to December 2011, a total of 114 cases with bladder tumor were enrolled in the study for 136 cases of E-TURBT by one surgeon. Patients were followed up for （4.82_44.1） years. Results Ninety-six （84.21%） patients had been cure by a single E-TURBT. The other 18 （15.79%） patients with recurrence tumors were treated by second E-TURBT, in those 13 （72.2%） were cured while only 5 （27.8%） patient suffered from second recurrences. In these 5 patients, 4 were treated by third E-TURBT and the other patient refused further treatment and died for cardiovascular disease. After the third E-TURBT, 2 （40%） patients were cured while 2 patients were diagnosed for metastasis at third recurrence. Totally 111 （97.37%） patients had been cured by E-TURBT. Conlusions E-TURBT is a new technique of TURBT. It can resect tumors more completely, avoid residual tumor, and reduce the recurrence rate with better therapeutic effect.