短周期二次经尿道膀胱肿瘤电切术联合化疗治疗T2期膀胱尿路上皮癌的临床分析

Clinical analysis of short-cycle secondary transurethral resection of bladder tumor combined with chemotherapy in the treatment of T2 urothelial carcinoma of bladder

目的探讨短周期二次经尿道膀胱肿瘤电切术联合术后化疗治疗T2期肌层浸润性膀胱癌的临床疗效。方法选取84例T2期膀膀胱尿路上皮癌患者,依据治疗方法分为观察组(n=41)和对照组(n=43)。两组患者均接受常规诊断性经尿道膀胱肿瘤电切术(TURBT),对照组患者予以常规根治性膀胱切除术+盆腔淋巴结清扫术+尿流改道,观察组患者于第一次常规诊断性TURBT术后4~6周再次行TURBT,两组患者术后均予以辅助吉西他滨+顺铂(GC方案)化疗。比较两组患者的手术相关指标、并发症发生率、复发情况和生存情况。结果观察组患者术中出血量明显低于对照组患者,手术时间、住院时间均明显短于对照组患者,差异均有统计学意义(P﹤0.01)。观察组患者术后并发症发生率9.76%(4/41),与对照组患者并发症发生率6.98%(3/43)比较,差异无统计学意义(P﹥0.05)。观察组患者复发转移率35.90%(14/39),与对照组患者的25.00%(10/40)比较,差异无统计学意义(P﹥0.05)。对照组患者1年总生存率90.00%(36/40),3年总体生存率65.00%(26/40),与观察组患者1年总生存率87.18%(34/39),3年总生存率58.97%(23/39)比较,差异均无统计学意义(P﹥0.05)。结论短周期二次经尿道膀胱肿瘤电切术联合化疗是一种治疗T2期膀胱尿路上皮癌安全有效的治疗方案。

Objective To evaluate the clinical efficacy of short-cycle secondary transurethral resection of bladder tumor(TURBT)combined with postoperative chemotherapy in the treatment of T2 muscle-invasive bladder cancer.Method Eighty-four patients with T2 urothelial carcinoma of bladder were enrolled in the analysis as study group(n=41)and control group(n=43)according to the respective therapeutic management administered.Both groups were treated with conventional diagnostic TURBT,besides,the control group was given conventional radical cystectomy combined with pelvic lymph node dissection and urinary diversion,while the study group received a short-cycle secondary TURBT 4~6 weeks after primary conventional diagnostic TURBT,chemotherapy of gemcitabine plus cisplatin(GC)was adopted in both groups after surgery.The surgical indicators,incidence of complications,recurrence and survival in both groups were recorded and compared.Result Significantly less intraoperative blood loss,shorter operative time and length of hospital stay were observed in study group compared to control group(P<0.01).The incidence of postoperative complications was 9.76%(4/41)in study group versus 6.98%(3/43)in control group,appearing no meaningful difference(P>0.05).The postoperative recurrence and metastasis rate in study group was 35.90%(14/39)compared to 25.00%(10/40)in control group,though the difference was only numerical(P>0.05).In the control group,the 1-year overall survival(OS)rate and 3-year OS rate were 90.00%(36/40)and 65.00%(26/40),respectively,which were similar to the 87.18%(34/39)and 58.97%(23/39)in study group correspondingly(P>0.05).Conclusion Short-cycle secondary transurethral resection of bladder tumor combined with chemotherapy is a safe and effective procedure for T2 urothelial carcinoma of bladder.