经尿道膀胱肿瘤电切除术术中留取切缘标本对非肌层浸润性膀胱癌的价值分析

Analysis of the Value of Transurethral Bladder Tumor Resection with Resection Margin Specimens for Non-muscular Invasive Bladder Cancer

目的探讨经尿道膀胱肿瘤电切除术术中留取切缘标本对非肌层浸润性膀胱癌的效果。方法选择101例行经尿道膀胱肿瘤电切术患者,其中47例术中留取切缘标本,记为A组;54例未留取切缘标本者为B组。观察A组患者的切缘阳性率、诊断、治疗方案变化情况,对比两组患者的复发率及进展率。结果 101例患者均完成手术,A组47例中切缘阳性率为19. 1%(9/47),其中肿瘤基底阳性6例,阳性率为12. 8%(6/47),肿瘤边缘阳性3例,阳性率为6. 4%(3/47)。9例切缘标本中Ta期占1例,占比2. 1%(1/47),T1期3例,占比6. 4%(3/47),T2期4例,占比8. 5%(4/47),Tis期1例,占比2. 1%(1/47)。A组中5例(10. 6%)患者根据切缘标本结果改变了诊断结果,8例(17. 0%)患者更改了术后的治疗方案,其中5例行二次电切术,占比10. 6%(5/47),2例行根治性膀胱切除术,占比4. 3%(2/47),1例行膀胱部分切除术,占比2. 1%(1/47)。B组患者仅行经尿道膀胱肿瘤电切术。A组的肿瘤复发率明显低于B组,P <0. 05;两组肿瘤进展率组间对比无统计学意义,P> 0. 05。结论经尿道膀胱肿瘤电切除术中留取切缘标本,可提高患者病理分期的准确性,以指导患者术后的治疗方案。

Objective To investigate the effect of transurethral bladder tumor resection with resection margin specimen on non-muscular invasive bladder cancer. Methods 101 cases with transurethral bladder tumor resection patients were selected,47 cases with incised margin specimens were group A,45 patients without excised margin specimens were group B. The change of positive rate,diagnosis and treatment regimen of incisional margin in group A patients were observed. The recurrence rate and progression rate in the 2 groups were compared. Results 101 patients completed the surgery,the positive rate of 47 patients in group A was 19. 1%( 9/47),6 patients with positive tumor base,the positive rate was 12. 8%( 6/47),and 3 patients with positive tumor edge,the positive rate was 6. 4%( 3/47). There was 1 case of Ta stage( 2. 1%,1/47),3 cases of T1 stage( 6. 4%,3/47),4 cases of T2 stage( 8. 5%,4/47),and 1 case of Tis stage( 2. 1%,1/47). In group A,5 patients( 10. 6%) changed the diagnosis results according to the results of marginal resection specimens,and 8 patients( 17. 0%) changed the postoperative treatment regimen,among which 5 patients underwent secondary resection,accounting for 10. 6%( 5/47),2 patients underwent radical cystectomy,accounting for 4. 3%( 2/47),and 1 patient underwent partial cystectomy,accounting for 2. 1%( 1/47). Patients in group B underwent transurethral and bladder tumor resection only. The recurrence rate of tumor in group A was significantly lower than that of group B( P < 0. 05). The tumor progression rate in group A and B had no statistically significant difference,P > 0. 05. Conclusion Transurethral and bladder tumor resection of the resection margin specimens can improve the pathological stating accuracy,in order to guide the postoperative treatment.