经尿道膀胱肿瘤电切术治疗肌层浸润性膀胱癌的临床疗效

Efficacy of transurethral resection of bladder tumor in the treatment of muscle-invasive bladder cancer

目的探讨经尿道膀胱肿瘤电切术治疗T2期肌层浸润性膀胱癌的临床疗效及安全性。方法回顾性分析101例肌层浸润性膀胱癌患者,所有患者术后病理均为浸润性尿路上皮癌(T2期),观察组84例行经尿道膀胱肿瘤电切术,将肿瘤位置膀胱壁全部切除,包括周围1.5 cm膀胱黏膜组织。对照组17例行根治性膀胱切除术,观察记录两组患者复发情况、并发症、生存率及生活质量等临床资料。结果观察组平均手术时间(53.1±10.3)min低于对照组的(202.4±31.5)min,观察组平均住院时间(11.7±1.7)d低于对照组的(28.0±4.7)d,观察组平均术中出血量(13.7±6.3)mL少于对照组的(470.6±143.1)mL,差异均有统计学意义(P<0.001)。观察组和对照组1、3、5年生存率分别为97.6%、84.5%、78.5%和94.1%、82.4%、76.4%,组间比较差异均无统计学意义(P>0.05)。观察组4例患者术后出现尿路感染,经抗炎对症治疗后痊愈。对照组1例患者出现肾积水行肾穿刺造瘘引流,1例患者出现输尿管梗阻,2例出现尿路感染行抗炎治疗,1例患者出现急性肠梗阻行手术治疗。观察组较对照组并发症发生率及住院费用低,保留膀胱,生活质量明显提高,患者满意度高。结论经尿道膀胱肿瘤电切术对于肿瘤单发、体积较小(直径≤2 cm)、分期较早(T2期)的肌层浸润性膀胱癌疗效可靠,安全性及术后生活质量高。对于肿瘤多发、体积较大(直径>2 cm)的肌层浸润性膀胱癌应首选根治性膀胱切除术。

Objective To investigate the clinical efficacy and safety of transurethral resection of bladder tumor（ TURBT） for T2 stage muscle invasive bladder cancer（ MIBC）. Methods The clinical data of 101 MIBC cases treated during Jan. 2008 and Feb. 2013 were retrospectively analyzed. All tumors were pathologically T2 stage. The patients were divided into the observation group（ n = 84） and control group（ n = 17）. Patients in the observation received TURBT,during which the bladder wall around the tumor was removed thoroughly,including 1.5 cm bladder mucosa.Patients in the control group underwent radical cystectomy and pelvic lymph node dissection. The recurrence,complications,survival rate and quality of life of the two groups were recorded and compared. Results The average operation time was shorter in the observation group than in the control group[（ 53.1±10.3） min vs（ 202.4±31.5） min]. The average hospitalization time was shorter in the observation group than in the control group [（ 11.7±1.7） d vs（ 28.0±4.7） d].The average intraoperative blood loss was less in the observation group than in the control group[（ 13.7±6.3） mL vs（ 470.6±143.1） mL]. The differences were statistically significant（ P〈0.001）. The 1-year,3-year and 5-year survival rate were 97.6%,84.5%,and 78.5% in the observation group,and were 94.1%,82.4% and 76.4% in the control group,with no statistical differences（ P〉0.05）. In the observation group,urinary tract infection occurred in 4 cases,who were cured after anti-infection treatment. In the control group,hydronephrosis,ureteral obstruction and acute intestinal obstruction occurred in 1 case respectively. The complication rate and hospitalization costs were lower in the observation group than in the control group. In the observation group,the bladders were preserved,and the quality of life was significantly improved. Conclusion For patients with T2 stage,sporadic,small size（ diameter ≤2 cm） MIBC,TURBT is safe and effective,and can improve patients＇ quality of life. For patients with multiple,large size（ diameter〉2 cm） MIBC,radical cystectomy is the first choice.