窄带成像与白光在经尿道膀胱肿瘤切除术中的自身对照分析

Analysis of self-control trial results of narrow band imaging and white light in transurethral resection of bladder tumor

目的:探讨窄带成像(narrow band imaging,NBI)辅助白光经尿道膀胱肿瘤切除术(transurethral resection of bladder tumor,TURBT)治疗膀胱尿路上皮癌的效果,总结NBI手术经验。方法:选择2018年4月至2020年1月北京大学第三医院泌尿外科就诊膀胱尿路上皮癌的患者,麻醉后行TURBT。术中先在白光下寻找膀胱肿瘤并切除,完整取出病理标本。换成NBI,寻找可疑病灶并切除,将病理标本完整取出。两组术后标本区分开分别送病理科,记录白光下病灶的数目、位置及病理诊断结果,同时记录NBI下白光残留病灶的情况。计算白光下电切后膀胱肿瘤残留的比例,评估NBI的效果。后期病例按时间顺序平均分为3组,统计各组的临床数据,观察NBI辅助白光下TURBT的学习曲线。结果:参加研究的患者共45例,其中男32例,女13例,年龄23~89岁,平均65.2岁。45例手术均顺利完成,术后未见明显并发症及发生。术中发现9例为单发,36例为多发,肿瘤最大径0.5~4.0 cm,平均2.2 cm。白光下切除标本病理诊断均为尿路上皮癌,另有19例白光切除后NBI辅助下再次切除标本病理诊断阳性(42.2%)。按时间顺序将45例分为3组,每组15例,白光下切除后3组NBI的真阳性率分别为33.3%、46.7%、46.7%,假阳性率分别为60.0%、46.7%、26.7%。结论:TURBT是治疗膀胱尿路上皮癌的有效方式,NBI是白光的有效补充,能增加膀胱肿瘤的检出率,减少术后复发。NBI光源有一定的学习曲线,随着病例的增加,NBI下假阳性率逐渐降低,而术者NBI经验丰富后,在白光下对扁平样肿瘤的辨识度也逐渐提高,白光下肿瘤切除后NBI辅助治疗肿瘤残留率降低。

Objective:To investigate the effect of NBI assisted white light transurethral resection of bladder tumor(TURBT)in the treatment of bladder urothelial carcinoma and to summarize the experience of narrow band imaging(NBI)operation.Methods:Patients with bladder urothelial carcinoma were selected,and TURBT was performed after anesthesia.First of all,the bladder tumor was found and resected under white light.Then we replaced with NBI,looked for suspicious lesions and resected them,The specimens excised under white light and NBI were collected separately.The number,location and pathological results of the lesions under white light were recorded,and the residual lesions under NBI were also recorded.To evaluate the effect of NBI,the ratio of residual bladder tumor was calculated.The cases were divided into three groups according to the time sequence.The clinical data of each group were collected and the learning curve of TURBT under NBI assisted white light was observed.Results:A prospective study of 45 patients with bladder tumor from April 2018 to January 2020,including 32 males and 13 females,aged from 23 to 89 years,with an average age of 65.2 years.All the operations were successfully completed,without obvious complications after operation.Nine cases were single and 36 cases were multiple.The maximum diameter of the tumors was 0.5 to 4.0 cm,with an average of 2.2 cm.The histopathology of the resected tissue under white light was urothelial carcinoma,and 19 cases(42.2%)were pathologically positive by NBI resection.The 45 cases were divided into three groups according to the time sequence,15 cases in each group.The true positive rate of NBI was 33.3%,46.7%and 46.7%,respectively,and the false positive rate was 60.0%,46.7%and 26.7%,respectively in the three groups.Conclusion:TURBT is an effective way to treat bladder urothelial cancer,NBI is an effective supplement of white light,which can increase the detection rate of bladder cancer and reduce post-operative recurrence.The NBI light source has a certain learning curve.With the increase of cases,the false-positive rate of NBI is gradually reduced.After the NBI operator has rich experience,the recognition degree of flat tumor is gradually improved under white light,and the residual rate of NBI is reduced after the removal under white light.