比较两种麻醉方式对非肌层浸润性膀胱癌复发的影响

Comparison of the effects of two anesthesia methods on recurrence of non-muscular invasive bladder cancer

目的比较两种麻醉方式对非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)术后复发的影响。方法回顾性分析2012年1月—2014年12月在本院治疗的534例原发性非肌层浸润性膀胱癌患者的临床资料,患者均行经尿道膀胱肿瘤切除术(transurethral resection of bladder tumor,TURBT),在麻醉医师建议或病人自愿选择的情况下选择蛛网膜下腔阻滞麻醉(spinal anesthesia,SA)或全身麻醉(general anesthesia,GA)。统计两种麻醉方式的人数,应用Kaplan-Meier生存分析及多因素COX比例危险度回归模型(Cox proportional hazards regression models简称COX回归模型)分析麻醉方式与NMIBC的复发关系。结果388例患者纳入研究,其中选择SA患者252列,复发人数为96例(38.10%),选择GA患者136例,复发人数为80例(58.82%),GA组复发率高于SA组,差异有统计学意义(P<0.001)。进行Kaplan-Meier生存分析及多因素Cox分析后,得出SA较GA的肿瘤复发率低,肿瘤复发的风险比在Cox回归模型中为0.634(P<0.001),在倾向评分匹配的Cox回归模型中为0.649(P<0.001),在调整后的逆概率处理加权法分析中,风险比为0.627(P<0.001)。结论采用GA进行TURBT手术的NMIBC患者术后更容易复发,条件允许下尽量采用SA。

Objective To compare the effects of two anesthesia methods on recurrence of non-muscular invasive bladder cancer (NMIBC). Methods We retrospectively analyzed the clinical records of 534 patients with primary NMIBC treated in our hospital from January 2012 to December 2014. All patients underwent transurethral resection of bladder tumor (TURBT). Spinal anesthesia (SA) or general anesthesia (GA) was selected on the recommendation of anesthesiologists or on patients’ choices. The number of patients who received the two kinds of anesthesia methods was calculated. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression models (Cox regression models) were used to analyze the relationship between anesthesia method and recurrence of NMIBC. Results A total of 388 patients were enrolled in the study,252 of 388 patients selected SA and 96 (38.10%) of the SA cases relapsed;136 of 388 patients selected GA,80 (58.82%) of the GA cases relapsed,the recurrence rate of GA group was higher than that of the SA group ( P <0.001). Kaplan-Meier survival analysis and multivariate Cox regression models analysis showed that SA had a lower recurrence rate than GA, the risk ratio of tumor recurrence was 0.634 ( P <0.001) in Cox regression models and 0.649 ( P <0.001) in Cox regression model with propensity score matching,and in the adjusted weighted inverse probability processing analysis,the risk ratio was 0.627 ( P <0.001). Conclusion The NMIBC patients who received GA for TURBT have higher rate of recurrence after operation. SA should be used as far as possible if conditions permit.