经尿道膀胱肿瘤电切术中活检的应用研究

Applied research of intra-operative biopsy during TURBT in the treatment of bladder cancer

目的探讨膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)中肿瘤基底部及边缘部位活检的应用价值及意义。方法收集2010年3月至2013年4月行TURBT术的膀胱癌患者58例,病理类型均为膀胱尿路上皮癌。术中活检28例(活检组),活检部位包括肿瘤基底部和创面边缘可疑黏膜;未活检30例(未活检组)。观察两组术后1年肿瘤复发、进展情况。结果 (1)活检组:1例活检发现肿瘤肌层浸润,行根治性全膀胱切除术;27例为非肌层浸润性尿路上皮癌,其中5例行二次TURBT,包括3例活检未见肌层组织及2例活检见上皮异形增生,另22例活检未见异常。随访1年,肿瘤复发5例,进展2例。(2)未活检组:2例为肌层浸润性膀胱癌,28例为非肌层浸润性膀胱癌。随访1年,肿瘤复发10例,进展6例。结论 TURBT术中行肿瘤基底部及边缘可疑部位活检,有助于明确肿瘤分期分级,提高残余肿瘤的检出率,明确电切范围及深度,并为二次TURBT提供参考依据。

Objective To evaluate the value and significance of intra-operative biopsy from the bottom and the margin of the tumors during TURBT in the treatment of bladder cancer.Methods 58 patients underwent TURBT with urothelial carcinoma from Mar.2010 to Apr.2013.28 patients underwent biopsy,the biopsy parts include the bottom and the margin of the tumors mucousmembrane,the left 30 patients did not receive biopsy. The recurrence and progression rates were observed one year after TURBT.Results （1）In biopsy group,one case biopsy specimen displayed muscle-invasive bladder cancer,radical total cystectomy was executed accord-ingly.5 patients did routine Re-TURBT including 3 patients with no signs of muscle tissues observed and 2 pa-tients with epithelial dysplasia in biopsy,the rest biopsy specimens were normal.During a one-year follow-up for 28 patients,5 patients had recurrence one year after TURBT in biopsy group along with 2 cases of progres-sion.（2）In non-biopsy group,2 cases showed muscle-invasive bladder cancer,28 cases were non-muscle in-vasive bladder cancer.During a one-year follow-up for 30 patients,10 patients had recurrence along with 6 ca-ses of progression in non-biopsy group.Conclusion Intra-operative biopsy from the bottom and the margin of the tumors during TURBT is helpful to identify the clinical staging and pathologic tumor grading,improving the detection rate of residual tumors,identifying the resection scope and depth,and providing reference for Re-TURBT.