二次电切在治疗非肌层浸润膀胱癌临床意义

Repeated transurethral resection of bladder tumor for non-muscle invasive bladder cancer

目的:比较常规经尿道膀胱肿瘤电切(TURBT)与经尿道膀胱肿瘤二次电切(Re-TURBT)两种不同手术方式治疗非肌层浸润性膀胱癌临床效果,研究影响二次电切肿瘤阳性率相关危险因素。方法:回顾性研究2007年1月~2012年12月在广西医科大学第一附属医院泌尿外科病区及肾移植科病区接受手术治疗并确诊为非肌层浸润性膀胱癌201例患者资料,按照是否行Re-TURBT分为2个研究组:常规行TURBT 169例及行Re-TURBT 32例。比较两组术后复发率、手术时间、术后住院天数、留置尿管天数况,分析其影响二次电切肿瘤阳性率的危险因素。结果:两种手术方式术后复发率差异有统计学意义(χ2=3.918,P【0.05)认为两种手术方式术后复发率有差别,二次电切术后复发率少于常规电切组,而两组手术时间(t=-0.195,P=0.846)、住院时间(t=1.423,P=0.156)、留置尿管天数(t=-0.466,P=0.642),均提示差异无统计学意义。根据logistic binary回归分析提示:首次电切时肿瘤为≥T1(χ2=4.891,P=0.04)、高级别肿瘤(G2及G3)(χ2=1.903,P=0.001)、肿瘤大小≥3cm(χ2=9.718,P=0.004)、多发肿瘤(≥3个)(χ2=6.203,P=0.02)均为二次电切阳性的独立危险因素,线性回归分析提示:首次电切肿瘤的病理级别对二次电切肿瘤阳性率影响最大。结论:Re-TURBT具有操作简单、手术安全性好、住院时间短、有效降低手术复发率等特点,对于首次电切为多发肿瘤、肿瘤较大(≥3cm)、高级别肿瘤及高分期肿瘤(≥T1期)等,尤其首次电切肿瘤为高级别肿瘤应常规行Re-TURBT。

Objective:To investigate the clinical efficacy of the first transurethral resection of bladder tumor (TURBT)vs.repeated TURBT (Re-TURBT)in the treatment of non-muscle invasive bladder cancer and study the associated risk factors influencing the tumor positive rate of Re-TURBT.Methods:The clinical data of 201 cases of non-muscle invasive bladder cancer undergoing surgical treatments in our hospital from July 2007 to December 2012 were retrospectively analyzed,and divided into two groups:1 69 patients undergoing conventional TURBT and 32 ca-ses undergoing Re-TURBT.Postoperative recurrence rate,operation time,postoperative hospital stay,and indwell-ing catheter time were compared between two groups.The associated risk factors influencing tumor positive rate of Re-TURBT were analyzed.Results:There was significant difference in postoperative recurrence rate between two groups (χ2 =3.918,P <0.05 ).There was no significant difference in operation time (t = -0.1 95,P =0.846 ), hospital stay (t =1.423,P =0.1 56),and indwelling catheter time (t =-0.466,P =0.642)between two groups. The logistic binary regression analysis showed the first TURBTfor ≥ T1 (χ2 =4.891,P =0.04),high grade tumors (G2 and G3 )(χ2 =1.903,P =0.001),tumor size more than 3 cm (χ2 =9.718,P =0.004),and multiple tumors (≥ 2)(χ2 =6.203,P =0.02)were independent risk factors of positive rate of Re-TURBT.The pathological grade of the first TURBT had a great contribution to the regression equation.Conclusions:Re-TURBT has the advantages of simple operation,safety in operation,short hospitalization time,reducd postoperative recurrence rate,with re-gard to the first TURBT for multiple tumors,larger tumors (≥ 3 cm),high grade tumors and high stage tumors (≥T1 )etc,especially the first TURBT for high grade tumor,Re-TURBT is given regularly.