T1G3期膀胱肿瘤经尿道二次电切的临床疗效分析

目的探讨二次经尿道膀胱肿瘤电切术（TURBT）治疗T1G3期膀胱肿瘤患者的临床疗效。方法回顾分析2005年1月至2011年12月在我院初次行TURBT治疗病理诊断为T1G3期膀胱肿瘤、并规律进行丝裂霉素膀胱灌注的49例患者资料。其中行二次TURBT治疗的患者19例（观察组），未行二次电切的患者30例（对照组）。观察两组间肿瘤复发率差异、残余肿瘤存在与否，以及肿瘤病理分期、分级的变化。结果二次电切后发现5例（26．3％）有残余肿瘤，3例（15．9％）有肿瘤分期的升高，其中1例改行根治性膀胱切除术。随访8～18个月（平均15个月），观察组有3例（15．9％）肿瘤复发，对照组13例（43．3％）肿瘤复发。结论二次TURBT可切除残存肿瘤，更准确了解肿瘤分期情况，是确定患者是否应行根治性膀胱切除的重要依据，并可明显降低肿瘤的复发与进展。

The clinical significance of the second transurethral resection for T1G3 bladder tumor

Objective In order to explore the clinical significance of the second transurethral resection for T1G3 bladder tumor （TURBT）. Methods Ninteen patients who were diagnosed T1G3 bladder tumor in the first operation, after 4 weeks underwent the second TURBT in the observed group. Meanwhile thirty who were diagnosed T1G3 bladder tumor underwent single TURBT as controls. Whether the existence of tumor residues, and the change in the pathological stage were observed. Two groups were studied according to the clinical outcomes of TURBT. Results Tumor residues were found in 5 patients （26.3%） with the second TURBT and pathological stage were found increased in 3 patients （15.9 %）, 1 patient insteaded the radical cystectomy of that. Tumor recurred in 3 patients （15.9%） in the observed group and 13 patients （43.3%） in the control group after fol- low-up for 8 to 18 months （15 months in average）. Conclusions The second TURBT is an effective method to treat the patients with T1G3 bladder tumor to reveal their actual situation, evaluated their stages. Besides it also can decrease recurrence and postpone the progression of the tumor. It is important to make sure whether the patients should undergo radical total cystectomy.