经尿道膀胱肿瘤电切变性术的疗效

Efficacy of transurethral resection and degeneration of bladder tumor

目的评估经尿道膀胱肿瘤电切变性术(TURD-Bt)的疗效和安全性。方法采用TURD-Bt治疗56例膀胱肿瘤,与32例行经尿道膀胱肿瘤电切术(TUR-Bt)进行对照研究。有和无肿瘤进展因素患者分别比较。结果随访时间TURD-Bt组(48.55±23.74)月,对照组(56.28±17.61)月。无肿瘤进展因素患者,TURD-Bt组无肿瘤复发,14例均生存;对照组3例(37.50%)复发,5例(62.5%)生存。有肿瘤进展因素患者,TURD-Bt组8例(19.05%)肿瘤复发,32例(76.19%)生存,肿瘤死亡3例(7.14%);TUR-Bt组18例(75.00%)复发(P<0.05),12例(50.00%)生存(P<0.01),8例(33.33%)肿瘤死亡(P<0.05)。TURD-Bt组无特殊并发症发生。结论 TURD-Bt术可彻底切除和凝固变性膀胱肿瘤,疗效显著提高。手术安全可靠,操作过程预期可控制。对没有淋巴和远处转移的膀胱肿瘤,TURD-Bt可替代根治性TUR-Bt,保留膀胱。

Objective To evaluate the efficacy and safety of transurethral resection and degeneration of bladder tumor （TURD-Bt）. Methods The results of 56 patients with bladder tumor treated with TURD-Bt were compared with the results of 32 patients treated with current transurethral resection of bladder tumor （TUR-Bt）. Patients with or without disease pro- gressive factors were respectively compared between the two groups, including recurrent tumor, multiple tumors, tumor diame- ter ≥3 cm, clinical stage T2, histological grade l]I, adenocarcinoma and ureteral obstruction or hydronephrosis. Results The follow-up lasted for （48.55±23.74） months for the TURD-Bt group and （56.28± 17.61） months for the TUR-Bt group （P〉0. 05）. Among patients without progressive factors, no tumor recurrence was found and the overall survival was 14 （100%） in the TURD-Bt group; 3 （37.50%） had recurrence and overall survival was 5 （62.5%） in the TUR-Bt group. Of pa- tients with progressive factors, 8 （19.05%） had tumor recurrence, overall survival was 32 （76.19%） and cancer death was 3 （7.14%） in the TURD-Bt group; 18 （75.00%） had tumor recurrence （P〈0.05）, overall survival was 12 （50.00%） （P〈0. 01） and cancer death was 8 （33.33%） （P〈0.05） in the TUR-Bt group. No significant complication was observed in the TURD-Bt group. Conclusion TURD-Bt can produce complete resection and degeneration of bladder tumor. The surgical procedure is safe, effective, predictable and controllable. For bladder tumor without lymph node metastasis and distal metasta- sis, TURD-Bt can be performed to replace radical TUR-Bt and preserve the bladder.