二次电切在非肌层浸润性膀胱癌的临床价值

目的 探讨二次电切在非肌层浸润性膀胱癌的应用价值.方法 回顾性分析我院37例非肌层浸润性膀胱癌患者的临床资料,所有患者进行首次电切后6周内进行二次电切,观察首次电切后的肿瘤残留情况、两次电切时的手术情况及二次电切后患者的无瘤生存状况.结果 首次电切及二次电切的手术时间分别为[（67.4±12.5）min vs （55.8±8.4）min,t=5.167,P＜0.01]、留置导尿管时间分别为[（9.8±2.1）d vs（9.4±1.9）d,t=0.730,P=0.468],首次电切后有6例患者（16.2％）存在肿瘤残留,3例患者（8.1％）出现肿瘤分期升高,其中1例由T1期肿瘤上升至T2期,2例患者由Ta期肿瘤上升至T1期;二次电切后在5～7年的长期随访中,复发10例（27.0％）,具体为术后的第13、16、19、21、29、42、58、66、73、76个月,随访期间共3例患者死亡,死亡原因与膀胱肿瘤无关.结论 二次电切可有效的发现肿瘤残留并及时处理,提高无瘤生存时间.     

二次经尿道双极等离子电切治疗非肌层浸润性膀胱癌

目的 探讨二次经尿道双极等离子电切术(Re-TURBt)治疗非肌层浸润性膀胱癌的疗效.方法 2005年12月至2010年10月共收治231例非肌层浸润性膀胱癌,男性175例,女性56例,年龄28～85岁.在初次经尿道双极等离子电切术后根据肿瘤分期和分级以及标本有无肌层组织进行评估,有63例患者在术后4～6周行Be-TU...     

非肌层浸润性膀胱癌的规范治疗

非肌层浸润性膀胱癌(NMIBC)发病率高,易复发、进展,治疗可采用多种手术方法和膀胱灌注药物,治疗方案对疗效影响大,具体治疗方式的选择仍存在很多争议。本文结合相关诊疗指南及最新研究进展,就如何规范地实施NMIBC手术及膀胱灌注治疗进行了探讨。     

非肌层浸润性膀胱癌灌注治疗新进展

膀胱癌是泌尿生殖系常见的恶性肿瘤之一,是一种直接威胁患者生存的疾病。经尿道膀胱肿瘤切除术既是非肌层浸润性膀胱癌的重要诊断方法,同时也是主要的治疗方案。单纯的经尿道膀胱肿瘤切除术后存在较高的肿瘤复发率与疾病进展率,故术后行膀胱灌注治疗能在一定程度上降低膀胱肿瘤复发与进展。研究者们针对膀胱灌注治疗药物、治疗方案的选择等进行了大量研究,旨在更好地提高灌注疗效,降低肿瘤复发,延缓疾病进展。现就近年来非肌层浸润性膀胱癌膀胱灌注治疗的新进展予以阐述与总结。     

非肌层浸润性膀胱癌患者术前是否需要常规行IVU检查

目的 探讨非肌层浸润性膀胱癌患者术前是否需要常规行IVU检查.方法 病理确诊为非肌层浸润性膀胱癌患者1968例.男1021例,女947例.年龄16～84岁,平均57岁.病理分期均为Ta～T1,细胞分级G11541例、G2382例、G345例.术前均行双肾输尿管膀胱超声、膀胱镜、IVU检查.均行经尿道膀胱肿瘤切除术.统计学比较分析不同检查方法上尿路癌的检出率.结果 1968例患者中同时发生上尿路癌216例(11.0%).1582例血尿者IVU检查发现上尿路癌215例(13.6%),386例偶然发现膀胱癌患者IVU检查发现上尿路癌1例(0.3%),有无血尿者IVU检查发现上尿路癌比例差异有统计学意义(P＜0.01).超声检查示上尿路异常者120例IVU检查均发现上尿路癌(100.0%),1848例超声检查上尿路无异常者IVU检查发现96例(5.2%),组间比较差异有统计学意义(P＜0.01);1247例超声检查上尿路无异常的单发肿瘤患者IVU检查发现上尿路癌37例(3.0%),601例多发者IVU检查发现59例(9.8%),组间比较差异有统计学意义(P＜0.01);超声检查上尿路无异常的单发膀胱肿瘤直径＜1.0 cm者IVU检查发现上尿路癌2例(0.2%),肿瘤直径≥1.0 cm者IVU检查发现35例(8.2%),组间比较差异有统计学意义(P＜0.01).G1患者同时发生上尿路癌48例(3.1%),G2～G3168例(39.3%),组间比较差异有统计学意义(P＜0.01).结论 非肌层浸润性膀胱癌患者中有血尿症状、超声检查上尿路异常者、超声检查上尿路未见异常的膀胱肿瘤多发或单发但直径≥1.0 cm者、膀胱镜检查肿瘤可疑高级别者应行IVU检查;偶发病例、单发肿瘤且直径＜1.0 cm、肿瘤低级别者,术前可不行IVU检查.

Abstract：

Objective To discuss the need for performing intravenous urography(IVU) in patients with non-muscle invasive bladder cancer before surgery. Methods From 1997 to 2008,1968patients were diagnosed as non-muscle invasive carcinoma of the bladder with pathological confirmation. All patients underwent ultrasonography, cystoscopy and IVU prior to surgrey. The x2 test was used for statistical analysis. Results The incidence of upper urinary tract urothelial tumors (UUTUT) was 11. 0% (216 cases). Two hundred and fifteen (13. 6%) suffered simultaneous UUTUT detected by IVU in 1528 patients with bladder cancer who had intermittent painless gross hematuria, while only 1 (0.3 %) suffered simultaneous UUTUT in 386 non-symptomatic patients (P＜0.01). Among 120 patients with bladder cancer whose upper tract was abnormal detected by ultrasonography,120 (100. 0%) suffered simultaneous UUTUT detected by IVU, and of 1848 patients who were normal in upper tract by ultrasonography, 96 (5. 2%) suffered simultaneous UUTUT detected by IVU (P＜0. 01). Of the patients with no abnormalities in upper tract by ultrasound, 37(3. 0%) suffered simultaneous UUTUT detcted by 1VU in 1247 patients with single bladder tumor,and 59 (9.8%) suffered simultaneous UUTUT in 601 patients with multiple bladder tumors (P＜0.01). Of the patients with single bladder tumor who had no abnormalities in upper tract by ultrasonography, 2 (0.2%) suffered simultaneous UUTUT detected by IVU in 822 patients with the diameter of the tumor＜1.0 cm, and 35 (8. 2 %) suffered simultaneous UUTUT in 425 patients with the diameter≥1. 0 cm (P＜0.01). Of the 1541 patients with histological G1, 48 (3.1%) suffered simultaneous UUTUT detected by IVU, and of the 427 patients with histological G2- G3, 168 (39. 3%)suffered simultaneous UUTUT (P ＜ 0. 01 ). Conclusion Patients with the following characters should undergo IVU before surgery: hematuria, abnormal upper urinary tract by ultrasonography,multifocal tumours, the diameter of the single bladder tumor≥1. 0 cm and high gradc tumors.     

非肌层浸润性膀胱癌患者术前是否需要常规行IVU检查

Objective To discuss the need for performing intravenous urography(IVU) in patients with non-muscle invasive bladder cancer before surgery. Methods From 1997 to 2008,1968patients were diagnosed as non-muscle invasive carcinoma of the bladder with pathological confirmation. All patients underwent ultrasonography, cystoscopy and IVU prior to surgrey. The x2 test was used for statistical analysis. Results The incidence of upper urinary tract urothelial tumors (UUTUT) was 11. 0% (216 cases). Two hundred and fifteen (13. 6%) suffered simultaneous UUTUT detected by IVU in 1528 patients with bladder cancer who had intermittent painless gross hematuria, while only 1 (0.3 %) suffered simultaneous UUTUT in 386 non-symptomatic patients (P＜0.01). Among 120 patients with bladder cancer whose upper tract was abnormal detected by ultrasonography,120 (100. 0%) suffered simultaneous UUTUT detected by IVU, and of 1848 patients who were normal in upper tract by ultrasonography, 96 (5. 2%) suffered simultaneous UUTUT detected by IVU (P＜0. 01). Of the patients with no abnormalities in upper tract by ultrasound, 37(3. 0%) suffered simultaneous UUTUT detcted by 1VU in 1247 patients with single bladder tumor,and 59 (9.8%) suffered simultaneous UUTUT in 601 patients with multiple bladder tumors (P＜0.01). Of the patients with single bladder tumor who had no abnormalities in upper tract by ultrasonography, 2 (0.2%) suffered simultaneous UUTUT detected by IVU in 822 patients with the diameter of the tumor＜1.0 cm, and 35 (8. 2 %) suffered simultaneous UUTUT in 425 patients with the diameter≥1. 0 cm (P＜0.01). Of the 1541 patients with histological G1, 48 (3.1%) suffered simultaneous UUTUT detected by IVU, and of the 427 patients with histological G2- G3, 168 (39. 3%)suffered simultaneous UUTUT (P ＜ 0. 01 ). Conclusion Patients with the following characters should undergo IVU before surgery: hematuria, abnormal upper urinary tract by ultrasonography,multifocal tumours, the diameter of the single bladder tumor≥1. 0 cm and high gradc tumors.     

非肌层浸润性膀胱癌患者术前是否需要常规行IVU检查

Objective To discuss the need for performing intravenous urography(IVU) in patients with non-muscle invasive bladder cancer before surgery. Methods From 1997 to 2008,1968patients were diagnosed as non-muscle invasive carcinoma of the bladder with pathological confirmation. All patients underwent ultrasonography, cystoscopy and IVU prior to surgrey. The x2 test was used for statistical analysis. Results The incidence of upper urinary tract urothelial tumors (UUTUT) was 11. 0% (216 cases). Two hundred and fifteen (13. 6%) suffered simultaneous UUTUT detected by IVU in 1528 patients with bladder cancer who had intermittent painless gross hematuria, while only 1 (0.3 %) suffered simultaneous UUTUT in 386 non-symptomatic patients (P＜0.01). Among 120 patients with bladder cancer whose upper tract was abnormal detected by ultrasonography,120 (100. 0%) suffered simultaneous UUTUT detected by IVU, and of 1848 patients who were normal in upper tract by ultrasonography, 96 (5. 2%) suffered simultaneous UUTUT detected by IVU (P＜0. 01). Of the patients with no abnormalities in upper tract by ultrasound, 37(3. 0%) suffered simultaneous UUTUT detcted by 1VU in 1247 patients with single bladder tumor,and 59 (9.8%) suffered simultaneous UUTUT in 601 patients with multiple bladder tumors (P＜0.01). Of the patients with single bladder tumor who had no abnormalities in upper tract by ultrasonography, 2 (0.2%) suffered simultaneous UUTUT detected by IVU in 822 patients with the diameter of the tumor＜1.0 cm, and 35 (8. 2 %) suffered simultaneous UUTUT in 425 patients with the diameter≥1. 0 cm (P＜0.01). Of the 1541 patients with histological G1, 48 (3.1%) suffered simultaneous UUTUT detected by IVU, and of the 427 patients with histological G2- G3, 168 (39. 3%)suffered simultaneous UUTUT (P ＜ 0. 01 ). Conclusion Patients with the following characters should undergo IVU before surgery: hematuria, abnormal upper urinary tract by ultrasonography,multifocal tumours, the diameter of the single bladder tumor≥1. 0 cm and high gradc tumors.     

非肌层浸润性膀胱癌的外科治疗选择

目前非肌层浸润性膀胱癌(NMIBC)的治疗以手术治疗为主,术后辅助规律膀胱灌注化疗。经尿道膀胱肿瘤切除术(TURBT)是治疗NMIBC的标准手术方式,但存在闭孔神经反射、癌组织残余率高、病理分期不准确、复发率高等问题。随着泌尿外科微创技术及设备不断发展,本文综合了文献报道和临床治疗体会,详细分析目前临床上NMIBC的外科治疗选择。     

非肌层浸润性膀胱癌的诊治现状及进展

在刚刚结束的2014年美国泌尿外科年会上,对非肌层浸润性膀胱癌的诊治策略进行了较为详细的阐述,总结了近年来较权威的一些观点,现介绍给大家,以供参考。根据统计学家预测[1],美国2014年将新发膀胱癌病例74 690例,死亡15 580例,约89%的患者年龄在55岁以上,是男性中在前列腺癌、肺癌、结直肠癌之后占第4位的肿瘤。在女性常见肿瘤中占第10位。也是从确诊到死亡花费最多的肿瘤之一。     

1470激光治疗非肌层浸润性膀胱癌的研究进展

膀胱癌是目前泌尿外科最常见的恶性肿瘤之一.世界范围内在所有恶性肿瘤中排第十二位,在泌尿系统恶性肿瘤位居第二位[1].膀胱癌每年新发病例为549,393例,死亡病例为199,922例[2].其中非肌层浸润性膀胱癌约占膀胱癌的70％[3].非肌层浸润性膀胱癌的治疗方法以手术治疗为主,辅助膀胱腔内灌注治疗.2019版中国泌尿...     

非肌层浸润性膀胱癌热灌注化疗研究进展

近期,膀胱热灌注化疗(CHT)在全球范围内逐步开展,显示出较好的应用前景,能充分发挥热疗和化疗的协同作用,其安全性和有效性已被许多实验和临床所证实,同时灌注设备亦不断更新,使许多膀胱癌患者从中受益。本文将膀胱瘤CHT的基础及临床研究进展进行综述。     

非肌层浸润性膀胱癌治疗中的争议性话题

膀胱癌是人类常见恶性肿瘤之一,2002年我国膀胱癌年龄标准化发病率男性为3．8／10万,女性为1．4／10万。近年来,我国部分城市肿瘤发病率报告显示膀胱癌发病率有增高趋势。对于非肌层浸润性膀胱癌来说,经尿道膀胱肿瘤电切术（TURBT）既是重要的诊断方法,同时也是主要的治疗手段。     

吸烟影响非肌层浸润性膀胱癌预后的研究进展

膀胱癌是与吸烟相关的常见恶性肿瘤之一。尽管大量研究已经证实吸烟是膀胱癌发生发展最主要的危险因素,但是吸烟对于膀胱癌的自然病程以及预后的影响了解甚少且存在争议。明确其对膀胱癌预后的影响,对降低膀胱癌的复发与进展以提高膀胱癌的生存率具有重要意义。本文着重对吸烟在非肌层浸润性膀胱癌预后中的研究进展做一综述。     

免疫治疗在非肌层浸润性膀胱癌治疗中的研究进展

膀胱灌注卡介苗(BCG)免疫治疗是高危非肌层浸润性膀胱癌(NMIBC)患者术后的一线治疗选择。然而,膀胱癌的高复发率仍无法有效控制。免疫治疗在各种恶性肿瘤中普遍应用,尤其PD-1/PD-L1抑制剂被批准应用于晚期肌层浸润性膀胱癌(MIBC)的治疗,为新型免疫治疗NMIBC提供了基础。本文就免疫治疗在NMIBC治疗领域的...     

非肌层浸润性膀胱癌免疫治疗研究进展及机制探讨

膀胱癌在泌尿系肿瘤中发病率很高,病理诊断为非肌层浸润性膀胱癌(NMIBC)患者治疗方案基本相同,以经尿道膀胱肿瘤电切(TURBT)及术后膀胱灌注化疗为主,术后复发进展较为常见。现普遍认为肿瘤是一种免疫性疾病,对癌细胞靶向杀伤且通过调节免疫系统功能有可能降低复发进展率。本文对重组卡介苗、基因疗法、肿瘤细胞疫苗、树突状细胞疫苗、单克隆抗体等免疫治疗手段进行归纳总结,分析其在膀胱癌中的应用前景,以期为基础实验研究提供新思路,为其在临床应用奠定理论基础。     

肌层浸润性膀胱癌的治疗现状

<正>膀胱癌是泌尿生殖系统最常见的恶性肿瘤。全球每年新增大约35万例病人,高居男性恶性肿瘤发病率的第7位,女性发病率排到第17位。2006年,膀胱癌在美国恶性肿瘤的排名高居第四位。国内膀胱癌的发病率要低于西方国家,男性及女性的膀胱癌发病率分别位居全身肿瘤的第8位和第12位之后。治疗方案较多,主要取决于肿瘤大小、数量、分期、分级及进展等,标准治疗方法是根治性膀胱切除术(radical cystectomy,RC),保     

非肌层浸润性膀胱癌复发尧进展预后的研究进展

尿路上皮癌是泌尿生殖系统常见的恶性肿瘤,新发患者约70%~80%为非肌层浸润膀胱癌(non-muscle-invasivebladder cancer,NMIBC).现在最关注的问题是肿瘤复发和向高级别高分期进展的预测,这决定患者术后药物灌注治疗、膀胱镜监测频次及是否采取更积极的治疗措施的选择.     

高危非肌层浸润性膀胱癌需要行再次电切

1标准的经尿道膀胱肿瘤切除术 标准的经尿道膀胱肿瘤切除术（transurethral resection of bladder tumor，TURBT）既是非肌层浸润性膀胱癌的重要诊断方法，同时也是主要治疗手段。膀胱肿瘤的确切病理分级、分期都需要借助TURBT后的病理结果获得。TURBT有两个目的：一是切除肉眼可见的全部肿瘤，