经尿道膀胱肿瘤剜除术治疗非肌层浸润性膀胱癌的应用价值

The efficacy of transurethral enucleation of bladder tumor in the treatment of non muscle-invasive bladder cancer

目的:探讨经尿道膀胱肿瘤剜除术(transurethral enucleation of bladder tumor,TUEBT)治疗非肌层浸润性膀胱癌(non mus-cle-invasive bladder cancer,NMIBC)的安全性及疗效。方法:回顾性分析2015年11月至2018年1月82例锦州医科大学附属第一医院NMIBC患者的临床病理资料,根据手术方式分为TUEBT组38例和经尿道膀胱肿瘤电切术(transurethral resection of bladdertumor,TURBT)组44例,比较两组的术中和术后指标及病理情况。结果:TUEBT组膀胱冲洗时间、留置尿管时间及术后住院时间分别为(21.00±3.55)h、(4.34±0.81)d、(5.29±0.96)d,少于TURBT组的(27.57±3.87)h、(5.32±0.83)d、(6.32±0.86)d,两组比较差异具有统计学意义(P<0.05)。TUEBT组手术时间为(29.55±4.13)min,长于TURBT组的(25.30±4.01)min;TUEBT组血红蛋白减少量为(2.00±0.38)g/dL,少于TURBT组的(2.30±0.32)g/dL;TUEBT组闭孔神经反射发生率为13.16%(5/38),低于TURBT组的34.09%(15/44);TUEBT组复发率为10.53%(4/38),低于TURBT组的29.55%(13/44);TUEBT组肌层缺失率为0(0/38),低于TURBT组的31.82%(14/44);TUEBT组符合二次经尿道切除术(repeat transurethral resection,ReTUR)标准例数为22例、TURBT组为33例,其中因肌层缺失而需ReTUR的TUEBT组为0、TURBT组为14例,TURBT组明显多于TUEBT组;两组比较差异均具有统计学意义(均P<0.05)。结论:TUEBT能够完整剜除肿瘤,保留肌层,提高病理分期的准确性,降低ReTUR概率,对NMIBC可获得满意的临床效果,其手术安全性及远期疗效与TURBT相比更具有优势。

Objective:To evaluate the safety and efficacy of transurethral enucleation of bladder tumor(TUEBT)in the treatment of non muscle-invasive bladder cancer(NMIBC).Methods:The clinical and pathological data of 82 NMIBC patients treated between November 2015 and January 2018 in the First Affiliated Hospital of the Jinzhou Medical University were retrospectively analyzed.The 82 NMIBC patients were divided into a TUEBT group(38 cases)and a transurethral resection of bladder tumor(TURBT)group(44 cases).The differences in intraoperative indices,postoperative indices,and pathological staging between the two groups were compared.Results:The bladder irrigation,indwelling catheter,and postoperative hospitalization times in the TUEBT group were(21.00±3.55)h,(4.34±0.81)d,and(5.29±0.96)d,respectively,compared with(27.57±3.87)h,(5.32±0.83)d,and(6.32±0.86)d in the TURBT group,and the differences between groups were statistically significant(P<0.05).The operative time in the TUEBT group[(29.55±4.13)min]was longer than in the TURBT group[(25.30±4.01)min].The hemoglobin decrease in the TUEBT group[(2.00±0.38)g/dL]was less than that in the TURBT group[(2.30±0.32)g/dL].The incidence of obturator nerve reflex in the TUEBT group was 13.16%(5/38),compared to 34.09%(15/44)in the TURBT group.The recurrence rate in the TUEBT group was 10.53%(4/38),compared to 29.55%(13/44)in the TURBT group.The detrusor deletion rate in the TUEBT group was 0(0/38),compared to 31.82%(14/44)in the TURBT group.The repeat transurethral resection(ReTUR)standard was met in 22 cases in the TUEBT group and 33 in the TURBT group.ReTUR due to lack of a detrusor was required in 0 cases in the TUEBT group and 14 in the TURBT group.The differences in the above clinical characteristics were statistically significant(P<0.05).Conclusions:TUEBT can remove a tumor completely,while preserving the detrusor,improving the accuracy of pathological staging,and reducing the probability of ReTUR.For NMIBC,TUEBT can obtain satisfactory clinical efficacy,with surgical safety and long-term efficacy superior to those of TURBT.