二次电切治疗单发广基型T_1G_3期膀胱尿路上皮癌临床分析

Clinical analysis of second transurethral resection in patients with solitary sessile T_1G_3 urothelial carcinoma of the bladder

目的探讨经尿道膀胱肿瘤二次电切术（二次电切）治疗单发广基型T1G3期膀胱尿路上皮癌的临床疗效。方法分析我院收集并随机分组的46例T1G3期膀胱尿路上皮癌患者资料。其中21例作为实验组于首次电切后4～6周行二次电切，明确有无肿瘤残留及确切的临床分期。与未接受二次电切患者（对照组）进行复发率、疾病进展率及无复发生存率的比较。结果两组患者性别、年龄、随访时间、肿瘤体积等的差异均无统计学意义（均为P〉0．05）．21例行二次电切的患者中，术后病理证实有肿瘤残余8例（38．1％），3例（14．3％）临床分期升高。术后平均随访时间（34±6．2）个月，对照组1年、3年、总复发率分别是：54．55％（12／17）、88．89％（16／18）、68％（17／25）；疾病进展率：70．59％（12／17）；实验组1年、3年、总复发率分别是：15．79％（3／19）、42．86％（6／14）、38．10％（8／21）；疾病进展率：37．5％（3／8）。二组相比，1年、3年、总复发率（Х^2=6．60，P〈O．05；P〈0．01；Х^2=4．11，P〈0．05）；疾病进展率（P=0．026）、无复发生存率（Х^2=7．28，P〈0．05）比较，差异均有统计学意义。结论二次电切可以降低T1G3期膀胱尿路上皮癌肿瘤残留率，并可以减少肿瘤的复发率、疾病进展率及改善无复发生存率。

Objective To explore the clinical significance of second transurethral resection （TUR） in patients with solitary sessile T1G3 urothelial carcinoma of the bladder. Methods A total of 46 patients with T1G3 urothelial carcinoma were recruited and randomized. Of these cases,21 were included in the experimental group,which underwent a second transurethral resection of bladder tumor （TURBT） 4-6 weeks after the first TURBT to detect the residual tumors and confirm the exact clinical stage. Tumor recurrence rate,progression rate and recurrence-free survival were compared with those of the other 25 cases in the control group who didn＇t undergo the second TURBT. Results There were no statistical differences in age,gender,size of tumors between the two groups. Of the 21 cases in the experimental group,8 （38.1%） had residual tumors and 3 （14.3%） were understaged. After an average follow-up of （34 ±6.2）months, the one-year, three-year,and overall recurrence rate of the control group were 54.55% （12/17） ,88.89% （16/18） and 68% （17/25） ,with the progression rate of 70. 59% （12/17） ,while those rates of the experimental group were 15.79% （3/19）,42.86% （6/14） and 38.10% （8/21）,with the progression rate of 37.5 % （3/8）. Patients who underwent a second TUR showed lower one-year, three-year,overall recurrence rate （Х^2= 6.60, P 〈0.05; P〈0.01; Х^2 =4.11, P〈0. 05） ,progression rate （P=0. 026） and longer recurrence-free survival （Х^2= 7.28, P〈0. 05） than those without a second TUR. Conclusions A second TUR decreases the residual rate of T1 G3 urothelial carcinoma of the bladder. It is beneficial to decrease the recurrence rate and tumor progression rate,and to improve the recurrence-free survival.