二次电切在非肌层浸润性膀胱癌诊疗中的意义

陈海戈* 曹明 潘家骅 孙杰 陈奇 陈勇辉 薛蔚

上海交通大学医学院附属仁济医院 泌尿科 上海200127上海仁济医院泌尿科陈海戈

摘要: [目的]: 调查对于膀胱非肌层浸润性尿路上皮癌患者在首次彻底电切4-6周后行二次电切的肿瘤阳性发现率以其相关因素。[方法]：回顾性分析了我院2004年3月到2009年6月进行的134例行二次电切的病例资料及随访情况。[结果]：134例二次电切标本中有52例发现阳性肿瘤，其中有41例肿瘤分期高于原先。二次电切的阳性与首次电切见为多发性肿瘤，高级别肿瘤和T1期肿瘤有关。随访发现二次电切阳性患者有更高的肿瘤复发与进展几率。而二次电切的手术并发症发生率与常规电切相似。[结论]：二次电切有较高的肿瘤阳性率并能提供更准确的病理分期信息，手术安全性良好。对于具有首次电切见为多发性肿瘤，高级别肿瘤和T1期肿瘤等危险因素的患者，可常规行二次电切。

Repeated transurethral resection for nonmuscle invasive bladder cancer

Haige Chen*, Ming Cao, Jiahua Pan, Jie Sun, Qi Chen, Yonghui Chen, Wei Xue

Department of Urology, Shanghai Renji Hospital, Medical School of Shanghai Jiaotong University. 1630, Dongfang Road, Shanghai, China. 200127

Purpose: To investigate the risk factors and positive rate of the repeated transurethral resection of bladder tumor performed 4-6 weeks after an initial TURBT for nonmuscle invasive bladder cancer.

Materials and Methods: From March 2004 to June 2009, 134 patients underwent a repeated TURBT were included in this study. The presence of residual tumor and the correlated risk factors, the complications of the second procedure and the changes of stage and grade between the two different TURBT were analyzed. 

Results: In the total 134 patients, residual tumor was present in 52 cases, and upgrading occurred for 41 patients. Patients with high grade, T1 stage and multifocality tumor at the initial TUR has a higher risk been found residual tumor in the second opinion. The progression and recurrence rate was higher in the patients with residual tumor in reTURBT. The complication of the repeated TURBT was predictable.

Conclusion: A high rate of residual tumor presence would be found in the repeated TURBT. And the second opinion could provide a more precise stage and the procedure was safe. We suggest repeated TURBT should be performed for the patients with high grade, T1 stage or multifocality nonmuscle invasive bladder cancer.

    膀胱癌是我国发病率最高的泌尿生殖系统恶性肿瘤，初次诊断的膀胱癌中大约80%为Ta或T1期肿瘤[1]。目前经尿道膀胱肿瘤电切术(TURBT)是非肌层浸润性膀胱癌的首选治疗，但手术后有很高的复发率，如何减少复发是非肌层浸润性膀胱癌诊疗的首要问题。很多学者支持在首次电切术后2至6周后再次进行电切手术(Re-TURBT)，范围包括膀胱内可见的复发或残余肿瘤、原电切疤痕处的肌层组织并且必要时还需做随机活检[2]。我们从2004年开始对于部分非肌层浸润性膀胱癌患者采取了Re-TURBT的治疗，现将观察到结果做一汇报。

1.       资料与方法：

1.1   临床资料：

*作者：陈海戈(1973)，副主任医师。联系方式：kirbyhaige@yahoo.com.cn