目的 探讨经尿道二次电切对治疗非肌层浸润性膀胱肿瘤的意义.方法 选取首次经尿道膀胱肿瘤电切术后均诊断为非肌层浸润性尿路上皮癌患者86例,其中Ta期28例,T1期58例.术后4～6周内接受二次电切,对两次术后的肿瘤组织病理学特点进行比较.结果 二次电切术后病理提示:无肿瘤者36例(41.9%);发现肿瘤残余病灶者35例(40.7%),发现肿瘤遗漏病灶者10例(11.6%);既发现残留病灶又发现遗漏病灶5例(5.8%).首次病理Ta期患者28例,二次术后17例(60.7%)无肿瘤,6例(21.4%)病理分期与首次相同,4例(14.3%)病理分期进展至T1期,1例(3.6%)病理分期进展至T2期;首次病理T1期患者58例,二次术后19例(32.8%)无肿瘤,8例(13.8%)病理分期下降至Ta 期,16例(27.6%)病理分期与首次相同,15例(25.9%)病理分期进展至T2期.Binary Logistic多元回归分析结果提示,首次电切术后肿瘤T1期、高分级、肿瘤直径＞3 cm、广基形外观是影响二次术后肿瘤分期升高至T2期的独立危险因素(P＜0.05).结论 经尿道膀胱肿瘤二次电切对于彻底切除肿瘤组织,明确肿瘤病理分期有相当重要的意义,从而有助于选择正确的后续治疗方案和评估预后.建议对首次术后病理提示T1期、高分级、肿瘤直径＞3 cm、广基形外观的膀胱肿瘤患者进行二次电切.%Objective To explore the significance of second transurethral resection in treating patients with newly diagnosed non - muscle invasive bladder cancer ( NMIBC ). Methods The research included 86 patients with stage Ta ( n = 28 ) and T, ( n = 58 ) bladder urothelial cancer. All patients underwent repeated TURBT ( Re - TURBT ) within 4 to 6 weeks after the initial resection. Pathologic findings of the second TURBT were compared with those of the initial one. Results Pathologic findings of Re - TURBT showed that 36 ( 41. 9% ) patients were tumor - free at the second operation. Residual malignant tissues were found in 35 ( 40. 7% ) patients while missed lesions were found in 10 (11. 6% ) patients. The other 5(5. 8% ) patients displayed coexisted residual and missed lesions. Of the 28 Ta patients of at the first TURBT, 17 ( 60. 7% ) were found to be tumor - free at Re - TURBT, 6 ( 21. 4% ) remained in stage Ta; 4 ( 14. 3% ) progressed stage T, and 1(3. 6% ) progressed to stage T2. Of the 58 patients of stage T, at the first TURBT, 19 ( 32. 8% ) were found to be tumor - free at Re - TURBT, 8 ( 13. 8% ) turned stage Ta; 16 ( 27. 6% ) remained in stage T, and 15 ( 25. 9% ) progressed to stage T2. Binary logistic multiple regression analysis revealed that T, stage at the first TURBT, high grade, diameters > 3 cm, and broadly - connected appearance were independent risk factors for progressing to stage T2 at Re - TURBT ( P <0. 05 ). Conclusion Re - TURBT is valuable for fully tumor resection and accurate staging of non - muscle invaded bladder cancer, which is required for selection of appropriate subsequent treating method and prognosis prediction. Re - TURBT is indicated for T, staging, high grade, lager size ( d > 3 cm ), and broadly - connected appearance.
展开▼
