经尿道膀胱肿瘤电切术加肿瘤基底扩大电灼治疗T_1期膀胱尿路上皮癌的疗效观察

目的:探讨经尿道膀胱肿瘤电切术(TURBT)加肿瘤基底部扩大电灼(EC)对减少非肌层浸润性膀胱尿路上皮癌早期复发的意义。方法:临床及病理诊断为非肌层浸润性膀胱尿路上皮癌400例,按收治顺序间隔分为TURBT+EC组和TURBT组各200例,前者在TURBT后加做EC,而后者则行标准TURBT。术后常规膀胱化疗和随访。所有患者均于术后1、3、6、12、18、24个月行膀胱镜检查。通过膀胱镜随访,统计两组2年内首次复发率。用χ2进行两组间率的比较。结果:TURBT+EC组和TURBT组得到随访的分别为191例和193例。TURBT+EC组第1、3、6、12、18、24个月复发率分别为3.7%(7例)、7.9%(15例)、7.9%(15例)、4.7%(9例)、2.1%(4例)、2.1%(4例);TURBT组复发率分别为11.4%(22例)、14.0%(27例)、11.9%(23例)、4.1%(8例)、3.1%(6例)、2.1%(4例)。TURBT+EC组的复发率明显低于TURBT组,两组数据经统计学处理,其中第1个月复发率比较,差异有统计学意义(P0.01);第3个月复发率比较,差异有统计学意义(P0.05);2年总的首次复发率分别为28.3%(54例)和46.6%(90例),差异有统计学意义(P0.01)。并且可以看出,对差异率的贡献主要是术后前3个月。结论:TURBT+EC可减低非肌层浸润性膀胱尿路上皮癌的术后复发率,对减少早期复发尤其有意义。可能得益于EC使基底部肿瘤残留几率的减低。并且几乎不增加手术创伤,技术简便。

TURBT plus excessive cauterization of tumour base in the treatment of T1 stage urotheliai carcinoma of the bladder

Objective： To evaluate the feasibility and effectiveness of TURBT plus excessive cauterization （EC） of tumour base in the prevention of short-term recurrence of non-muscle invasive urothelial carcinoma of the blad- der. Method： Four hundred cases suffered from non-muscle invasive urothelial carcinoma of the bladder underwent TURBT and just after the surgical procedure they were divided into TURBT＋EC group （200 cases） and TURBT group （200 cases） one by one sequentially. Then EC was carried out on those who included in TURBT＋EC group and the others who included in TURBT group, the operations finished. Cystoscopies were performed for all pa- tients at one, three, six, twelve, eighteen, twenty-four months after the operation respectively. The recurrence rates of the two groups have been surveyed and χ2 test was used for statistical analysis. Result： One hundred and ninety-one cases from TURBT ＋ EC group and 193 from TURBT group had been followed up. At one, three, six, twelve, eighteen, twenty-four months postoperatively, cystoscopic and pathological findings revealed the re- currence rates of the TURBTq-EC group were 3.7% （7 cases）, 7.9% （15 cases）, 7.9% （15 cases）, 4. 7% （9 cases）, 2.1% （4 cases）, 2.1% （4 cases） and the TURBT group were 11.4~ （22 cases）, 14.0~% （27 cases）, 11.9% （23 cases）, 4. 1% （8 cases）, 3. 1% （6 cases）, 2. 1% （4 cases） respectively. There were significant differences in recurrence rate of one and three months postoperatively between two groups （ P 〈0.01 and P 0.05 respectively）. Moreover, the total recurrence rates within two-year follow-up showed greatly differences （ P 〈0.01）. The recurrence rate of TURBTq-EC group was significantly lower than that of TURBT group and the differences had been made mainly within the first postoperative three months. Conclusion： As non-muscle invasive urothelial carcinoma of the bladder is concerned, TURBT-＋-EC may reduce the postoperative recurrence rate by ablation of residual tumour. Such technique is safe and easy-to-operate.