经尿道膀胱肿瘤电切术加肿瘤基底扩大电灼治疗T_1期膀胱尿路上皮癌的疗效观察

TURBT plus excessive cauterization of tumour base in the treatment of T_1 stage urothelial carcinoma of the bladder

目的:探讨经尿道膀胱肿瘤电切术(TURBT)加肿瘤基底部扩大电灼(EC)对减少非肌层浸润性膀胱尿路上皮癌早期复发的意义。方法:临床及病理诊断为非肌层浸润性膀胱尿路上皮癌400例,按收治顺序间隔分为TURBT+EC组和TURBT组各200例,前者在TURBT后加做EC,而后者则行标准TURBT。术后常规膀胱化疗和随访。所有患者均于术后1、3、6、12、18、24个月行膀胱镜检查。通过膀胱镜随访,统计两组2年内首次复发率。用χ2进行两组间率的比较。结果:TURBT+EC组和TURBT组得到随访的分别为191例和193例。TURBT+EC组第1、3、6、12、18、24个月复发率分别为3.7%(7例)、7.9%(15例)、7.9%(15例)、4.7%(9例)、2.1%(4例)、2.1%(4例);TURBT组复发率分别为11.4%(22例)、14.0%(27例)、11.9%(23例)、4.1%(8例)、3.1%(6例)、2.1%(4例)。TURBT+EC组的复发率明显低于TURBT组,两组数据经统计学处理,其中第1个月复发率比较,差异有统计学意义(P<0.01);第3个月复发率比较,差异有统计学意义(P<0.05);2年总的首次复发率分别为28.3%(54例)和46.6%(90例),差异有统计学意义(P<0.01)。并且可以看出,对差异率的贡献主要是术后前3个月。结论:TURBT+EC可减低非肌层浸润性膀胱尿路上皮癌的术后复发率,对减少早期复发尤其有意义。可能得益于EC使基底部肿瘤残留几率的减低。并且几乎不增加手术创伤,技术简便。

Objective： To evaluate the feasibility and effectiveness of TURBT plus excessive cauterization （EC） of tumour base in the prevention of short-term recurrence of non-muscle invasive urothelial carcinoma of the blad- der. Method： Four hundred cases suffered from non-muscle invasive urothelial carcinoma of the bladder underwent TURBT and just after the surgical procedure they were divided into TURBT＋EC group （200 cases） and TURBT group （200 cases） one by one sequentially. Then EC was carried out on those who included in TURBT＋EC group and the others who included in TURBT group, the operations finished. Cystoscopies were performed for all pa- tients at one, three, six, twelve, eighteen, twenty-four months after the operation respectively. The recurrence rates of the two groups have been surveyed and χ2 test was used for statistical analysis. Result： One hundred and ninety-one cases from TURBT ＋ EC group and 193 from TURBT group had been followed up. At one, three, six, twelve, eighteen, twenty-four months postoperatively, cystoscopic and pathological findings revealed the re- currence rates of the TURBTq-EC group were 3.7% （7 cases）, 7.9% （15 cases）, 7.9% （15 cases）, 4. 7% （9 cases）, 2.1% （4 cases）, 2.1% （4 cases） and the TURBT group were 11.4~ （22 cases）, 14.0~% （27 cases）, 11.9% （23 cases）, 4. 1% （8 cases）, 3. 1% （6 cases）, 2. 1% （4 cases） respectively. There were significant differences in recurrence rate of one and three months postoperatively between two groups （ P 〈0.01 and P 0.05 respectively）. Moreover, the total recurrence rates within two-year follow-up showed greatly differences （ P 〈0.01）. The recurrence rate of TURBTq-EC group was significantly lower than that of TURBT group and the differences had been made mainly within the first postoperative three months. Conclusion： As non-muscle invasive urothelial carcinoma of the bladder is concerned, TURBT-＋-EC may reduce the postoperative recurrence rate by ablation of residual tumour. Such technique is safe and easy-to-operate.