经尿道膀胱肿瘤电切术治疗复发性非肌层浸润性膀胱尿路上皮癌

目的探讨经尿道膀胱肿瘤电切术（transurethral resection of bladder tumor,TURBT）治疗复发性非肌层浸润性膀胱尿路上皮癌的疗效。方法本组复发性非肌层浸润性膀胱尿路上皮癌63例,肿瘤单发36例,多发27例。肿瘤直径0.2~3.0cm,术前均经膀胱镜检查,活检病理检查确诊为低级别尿路上皮癌。所有患者均行TURBT,术后常规卡介苗或化疗药物膀胱灌注,定期复查膀胱镜。结果 63例均顺利完成手术,无严重手术并发症。术后61例获得随访,随访时间8~62个月,平均36个月,38例长期稳定,未见复发;23例复发,复发率37.7%（23/61）。其中17例再次行TURBT,手术后9例病情稳定,8例术后再次复发,再行TURBT1~4次（其中5例临床分期增至T2,鉴于患者高龄或全身情况较差,仍采用TURBT治疗）;6例术后复发,因临床分期增加至T2~T3,行开放手术,其中2例行膀胱部分切除术,4例行根治性膀胱切除术。随访期间死亡2例。结论对于复发性非肌层浸润性膀胱尿路上皮癌,TURBT安全性高,并发症少,疗效确切。对于进展为T2期的老年体弱膀胱癌患者,多次TURBT可改善生活质量,延缓患者生命,可有选择性地应用。

Transurethral resection of bladder tumor for recurrent non-muscle-invasive urothelial carcinoma of the bladder

Objective To evaluate the efficacy of transurethral resection of bladder tumor（TURBT）for recurrent non-muscle-invasive urothelial carcinoma of the bladder.Methods To analyze the clinical data of 63 patients of recurrent non-muscle-invasive urothelial carcinoma of the bladder treated by TURBT.The tumor lesion was single in 36 and multiple in 27 patients.The diameter of the tumor was 0.2-3.0 cm,the patients were pathologically confirmed to be low-grade urothelial carcinoma by biopsy.All the patients were treated with postoperative intravesical instillation therapy and cystoscopy regularity.Results All the 63 patients finished operation successfully without serious complication.61 cases were followed-up for 8 to 62 months with a mean period of 36 months.23 patients（37.7%）had recurrence,and were treated with RE-TURBT in 17 patients,and partial cystectomy in 2 patients,radical cystectomy in 4 patients.In the 17 patients treated with RE-TURBT,8 patients had recurrence and were treated with RE-TURBT for 1-4 times again,among them 5 patients who had transformed T2 tumour were treated with RE-TURBT because of the advanced age and bad physiclal status.2 patients died,the mortality rate was 96.7%（59/61）.Conclusions TURBT for recurrent non-muscle-invasive urothelial carcinoma of the bladder is an effective method,which has the advantages of safety,less complications and good effect.Iterative TURBT is suitable for the selected old or weak patients with T2 bladder cancer,which can prolong the survival time and improve the quality of patients life.