摘要
目的 比较根治性膀胱切除术与经尿道电切术在治疗肌层浸润性膀胱癌的疗效,分析影响患者预后的危险因素。方法 整群选取2005年1月-2012年10月于该院泌尿外科诊治的肌层浸润性膀胱癌患者69例,其中33例患者行尿道电切治疗（电切组）,术后给予静脉、膀胱灌注化疗,36例行根治性膀胱切除术（根治组）,术后给予静脉化疗。对患者进行为期3年的随访,比较两组的手术时间、术中失血量、累积住院时间、肿瘤3年无复发生存率（RFS）、3年存活率（OS）等。行Log-rank单因素和Cox多因素回归分析潜在危险因素。结果 与根治组相比,电切组在手术时间、失血量以及住院时间上明显少于对照组,差异具有统计学意义（t=-22.020、-18.393、-7.205,P〈0.01）;两组患者在复发率及3年存活率上差异无统计学意义（χ2=0.338、0.361,P〉0.05）;Log-rank单因素分析显示,肿瘤直径≥5 cm及T 3期患者的预后较差,为3年RFS及OS的危险因素（χ2=8.183、21.548、8.427、12.410,P〈0.01）;进一步行Cox多因素分析,肿瘤直径≥5 cm为术后患者3年RFS的危险因素（RR=3.658,95%CI：1.875~7.137,P〈0.01）,T 3期和肿瘤直径≥5 cm为影响患者3年OS的危险因素（P〈0.01）。结论 经尿道膀胱肿瘤电切术的手术风险较小,联合辅助静脉、膀胱灌注化疗能够到良好的治疗效果,肿瘤直径≥5 cm、T3期是影响膀胱癌患者预后的重要危险因素。
Objective To compare the efficacy between radical cystectomy and transurethral electroresection in the treatment of muscle-invasive bladder cancer, and analyze the risk factors affecting the prognosis of the patients. Methods 69 cases with muscle-invasive bladder cancer diagnosed and treated in Department of Urologic Surgery of our hospital from January 2005 to October 2012 were selected and divided into the electroresection group（33 cases） and the radical group（36cases）. Patients in the electroresection group were treated by transurethral electroresection of bladder tumor and postoperative intravenous and bladder perfusion chemotherapy, and those in the radical group were treated by radical cystectomy with postoperative intravenous chemotherapy. A 3-year follow-up was given to the patients. The duration of procedure, intraoperative blood loss, cumulative hospitalization time, 3-year recurrence-free survival（RFS）, and 3-year overall survival（OS）and so on were compared between the two groups. Potential risk factors were analyzed by univariate Log-rank and multivariate Cox regression. Results Compared with the radical group, the electroresection group had much shorter duration of procedure, much less intraoperative blood loss and obviously shorter length of stay（t=-22.020,-18.393,-7.205, P0.01）.The difference in the recurrence rate and 3-year survival rate between the two groups was not statistically significant（χ2=0.338, 0.361, P0.05）. Log-rank single factor analysis showed that, the prognosis of patients with the diameter of tumor ≥5 cm and T3 stage was poor; diameter of tumor ≥ 5 cm and T3 stage in patients were the risk factors of 3-year RFS and3-year OS（χ2=8.183, 21.548, 8.427, 12.410, P0.01）. Cox multivariate analysis showed that, the diameter of tumor ≥ 5 cm was the risk factor of 3-year RFS（RR=3.658, 95% CI： 1.875~7.137, P0.01）; T3 stage and tumor diameter ≥ 5 cm were the risk factors related to 3-year OS（P0.01）. Conclusion There is low risk of operation in transurethral electroresection of bladder tumor. Transurethral electroresection of bladder tumor combined with intravenous and bladder perfusion chemotherapy can achieve good therapeutic effect. The tumor diameter ≥5 cm and T3 stage are the important risk factors affecting the prognosis in patients with bladder cancer.
出处
《中外医疗》
2016年第5期21-23,共3页
China & Foreign Medical Treatment
