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。     

再次经尿道电切术治疗T1期膀胱肿瘤

目的 评价再次经尿道电切术治疗T1期膀胱癌的疗效.方法 48例初次电切术后的T1期膀胱癌患者,4~6周后行再次经尿道电切术(Re-TURbt).结果 48例患者均手术成功.48例患者中,33.3%(16/48)发现有肿瘤残留,其中11例肿瘤未侵犯肌层,Ta期4例,T1期7例;5例(10.4%)肿瘤侵犯肌层,分期被低估.随访6～26个月,有5例复发.结论 T1期膀胱癌患者术后4~6周后行Re-TURbt能发现残留肿瘤,提高分期的准确性.     

Ta期膀胱癌经尿道电切加膀胱内灌注治疗后的长期随访

目的　研究Ta期膀胱移行细胞癌(BTCC)经尿道电切加膀胱内灌注治疗的预后及相关因素。　方法　88例初发TaBTCC患者。男62例,女26例。平均年龄61岁(41 ~81岁)。G1 26例、G2 61例、G3 1例。单发者62例(G1 16例,G2 45例,G3 1例),多发者26例(G1 10例,G2 16例)。均行经尿道膀胱肿瘤电切术及膀胱内灌注治疗。平均随访113个月(56 ~168个月),分析肿瘤复发和进展情况及与初发肿瘤分化及数目间的关系。　结果　全组复发53例(60% )。单发肿瘤组16例G1 肿瘤者中复发4例(25% ), 45例G2 者中复发28例(62% ),总复发率为52% (32 /62);多发肿瘤组10例G1 中复发8例(80% ), 16例G2 者中复发12例(75% ),总复发率77% (20 /26)。原发肿瘤为多发者手术后复发率明显高于单发者(P<0. 01),单发肿瘤组中G2 患者复发率明显高于G1 者(P<0. 001)。多发肿瘤组中肿瘤分级与复发率无明显相关差异。G1 肿瘤组复发病例中无肿瘤进展, 40例G2 者中17例(42. 5% )复发时出现肿瘤进展,其中进展为T1G2 者12例,进展为T2G2 者5例。术后膀胱灌注噻替哌、丝裂霉素、卡介苗各组肿瘤复发率分别为75% (12 /16)、68% (30 /44)、40% (11 /27)。1例因癌特异死亡者为TaG3。　结论　多发的Ta膀胱移行细胞癌在经尿道膀胱肿瘤电术加膀胱内灌注治疗后有较高的复发     

膀胱癌保留膀胱的手术治疗

据世界卫生组织2002年统计,全球每年约有36万新发膀胱癌病例,发病率居恶性肿瘤第九位,发病率呈现逐年上升趋势,从1985年至2000年,肿瘤年发病率增加了33%.2009年美国预计有70 980例新诊断的膀胱癌患者,14 330例患者将会死于该疾病[1].     

经尿道双极等离子电切系统治疗膀胱癌85例报告

目的探讨应用经尿道双极等离子电切系统治疗膀胱癌的安全性和疗效。方法采用英国Gyrus公司的经尿道双极等离子电切系统行经尿道膀胱肿瘤电切术(transurethral resection of the bladder tumor,TURBT)治疗膀胱癌85例,切割电极切除肿瘤直达深肌层,同时扩大到电切距肿瘤基底1 cm范围的正常组织,术后定期膀胱内灌注吡柔比星。结果手术时间10~52 min,平均23 min。术中发生闭孔神经反射19例,其中腹膜外穿孔2例。64例随访3~72个月,平均21个月,复发17例(术后6~12个月3例复发,1~2年9例复发,2~5年5例复发),行1~4次电切8例,膀胱部分切除5例,全膀胱切除4例;死亡2例,其中1例死于心机梗死,另1例死于肿瘤广泛转移。结论双极等离子电切系统行TURBT治疗浅表性膀胱癌是一种安全有效的方法,但仍要防止闭孔神经反射的发生。     

经尿道膀胱癌电切术后丝裂霉素膀胱内灌注的护理

<正> 经尿道膀胱癌电切术(TURBt)是近年来腔内泌尿外科应用较广的一种方法,可保留膀胱功能,与开放手术相比具有手术时间短,对病人打击小,痛苦小,术后恢复快,无肿瘤腹壁种植的危险。一般适用于直径2cm以下,表浅、恶性程度低的肿瘤。但表浅膀胱肿瘤复发率较高,故应采用膀胱内化疗药物灌注等作为TURBt术后预防复发的措施。我科采用丝裂霉素间歇长疗程膀胱内灌注能有效地预防或延迟膀胱癌的复发,现将     

TURBT联合膀胱内BCG灌注治疗肌层浸润性膀胱癌疗效分析

目的 探讨选择性经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)治疗经选择的肌层浸润性膀胱尿路上皮癌患者保留有功能性膀胱的可行性.方法 回顾性分析大连医科大学附属第二医院2006年至2011年间323例行TURBT治疗的膀胱尿路上皮癌患者的临床资料,选择术前影像学检查无明显膀胱外浸润,肿瘤单发,直径5 cm以下,局限于膀胱顶壁、底壁及侧壁,距输尿管口1 cm以上,不伴有原位癌,肿瘤创缘及基底部活检为阴性的T2期患者为研究对象,接受选择性TURBT伴膀胱内灌注BCG的保膀胱治疗.术后膀胱镜密切随访5~10年,运用统计学分析生存率、疾病特异生存率和无复发生存率评价疗效.结果 入组31例患者,5年总体生存率、疾病特异生存率和无复发生存率分别为87%、93%和58%.复发15例,浅表性复发6例,8例接受延迟膀胱癌根治术.23例保留有功能性膀胱,死亡6例.结论 选择性TURBT治疗肌层浸润性膀胱癌在少部分经严格选择的患者中是合理可行的,术后患者应终生接受膀胱镜严密随访.     

经尿道激光气化术治疗浅表性膀胱癌的疗效观察及安全性评估

目的 观察经尿道激光汽化术治疗浅表性膀胱癌的疗效及安全性.方法 选择在我院就诊的浅表性膀胱癌患者120例作为研究对象,随机分为观察组和对照组,观察组给予经尿道激光气化术治疗,对照组采用经尿道膀胱肿瘤电切术治疗,观察2组手术相关指标、应激指标以及远期预后情况.结果 观察组平均手术时间[(72.21±8.42)min]、术中出血量[(43.73±4.79)mL]、术后引流量[(11.93±1.43)mL]、术后卧床上时间[(1.87±0.23)d]、血糖水平[(4.28±0.44)mmol/L]、HAMA评分(15.41±1.76)、HAMD评分(13.41±1.46)、NRS评分(2.29±0.36)、以及复发率[8.33％(5/60)]均明显低于对照组;胰岛素水平[(13.31±1.56)U/mL]、生活质量评分85.12士8.91、KPS评分86.84±9.34明显高于对照组.结论 经尿道膀胱肿瘤激光气化术能够减小手术创伤、缓解术后应激、改善远期预后,具有积极的临床价值.     

男性尿道癌3例报告

男性尿道肿瘤少见 ,尿道癌更罕见。我院泌尿外科 2 0年来仅发现 3例 (均在 1997～ 1998年 ) ,现报告如下。1　资料和方法1 1　临床资料　例 1,6 2岁 ,反复尿频、尿急、排尿费力 8个月伴肉眼血尿 2个月。体检无异常发现。尿细胞学检查阳性 ;尿路静脉造影术 (ＫＵＢ ＩＶＰ)未见     

保留膀胱手术治疗肌层浸润性膀胱癌临床分析

目的:探讨肌层浸润性膀胱癌(muscle invasive bladder cancer,MIBC)行保留膀胱手术治疗的可行性及临床价值。方法:回顾性分析43例MIBC患者的临床资料:男28例,女15例,年龄45～88岁,平均62岁。其中38例(88.4%)行经尿道膀胱肿瘤电切除术(transurethral resection of bladder tumor,TURBT),5例(11.6%)行膀胱部分切除术;术后均行膀胱灌注化疗或放疗。结果:术后病理分期:T236例(83.7%),T37例(16.3%);病理分级:G14例(9.3%),G231例(72.1%),G38例(18.6%)。术后随访6～126个月,平均63.2个月;首次复发为3～20周,平均10.2周,复发次数1～8次,平均3.7次;共行2～9次TURBT,平均3.5次,其中25例(58.1%)于≥3次TURBT后出现病理性进展,9例(20.9%)于术后复发次数≥3次后改行根治术;2例(4.7%)死于非膀胱癌疾病,1例(2.3%,病理为T2G1)于首次术后126个月死于膀胱癌多发转移。结论:对于MIBC,可选择性行以TURBT为主加放化疗的保留膀胱手术治疗,但具有反复复发及进展倾向;首次复查膀胱镜时间需提前到术后4～8周,远期疗效需进一步评估。     

二次电切对T1G3期膀胱肿瘤疗效影响的回顾性分析

目的：探讨T1G3期膀胱肿瘤患者行第二次经尿道膀胱肿瘤电切术（TURBT）治疗的临床意义。方法：收集2005年1月～2010年4月,初次TURBT治疗后病理诊断为T1G3期膀胱肿瘤患者4周内行第二次TURBT治疗共23例（观察组）。以同期行TURBT后诊断为T1G3期膀胱肿瘤,但未行二次电切的37例患者为对照。两组患者术后均予以羟喜树碱行膀胱灌注治疗,观察两组间肿瘤复发率差异,残余肿瘤存在与否及位置,肿瘤病理分期、分级的变化,根据第二次TURBT的结果采取的不同治疗方案．结果：二次电切后发现7例（30％）有残余肿瘤,5例（23％）有肿瘤分期的升高,其中3例改行根治性膀胱切除术。随访10n18个月（平均13个月）,有4例（17％）肿瘤复发。对照组19例（52％）肿瘤复发。结论：第二次TURBT治疗检测残存肿瘤,揭示肿瘤分期情况,提前确定患者是否应行根治性膀胱切除的重要依据及可明显降低肿瘤的复发与进展。     

Bladder-sparing protocols in the treatment of muscle-invasive bladder cancer

Bladder-sparing protocols (BSP) have been gaining widespread popularity as an attractive alternative to radical cystectomy (RC) for muscle-invasive bladder cancer. Unimodal therapies are inferior to multimodal regimens. The most promising regimen is trimodal therapy (TMT), which is a combination of maximal transurethral resection of bladder tumor (TURBT), radiotherapy, and chemotherapy. In appropriately selected patients (low volume unifocal T2 disease, complete TURBT, no hydronephrosis and no carcinoma-in-situ), comparable oncological outcomes to RC have been reported in large retrospective studies, with a potential improvement in overall quality of life (QOL). TMT also offers the possibility for definitive therapy for patients who are not surgically fit to undergo RC. Routine biopsy of previous tumor resection is recommended to assess response. Prompt salvage RC is required in non-responders and for recurrent muscle-invasive disease, while non-muscle-invasive recurrence can be managed conservatively with TURBT +/− intravesical BCG. Long-term follow-up consisting of routine cystoscopy, urine cytology, and cross-section imaging is required. Further studies are warranted to better define the role of neoadjuvant or adjuvant chemotherapy in the setting of TMT. Finally, future research on predictive markers of response to TMT and on the integration of immunotherapy in bladder sparing protocols is ongoing and is highly promising.     

Complete transurethral resection of bladder tumor before radical cystectomy is not a risk factor for organ-confined bladder cancer: A case-control study

ObjectivesTo investigate the role of complete transurethral resection of bladder tumor (TURBT) before radical cystectomy (RC) for organ-confined bladder cancer.Materials and methodsData of patients who underwent RC in our center from January 2008 to December 2018 were retrospectively reviewed. Patients with >T2N0M0 disease and positive surgical margins and those who received neoadjuvant/adjuvant chemotherapy or radiotherapy were excluded. Complete TURBT was defined as no visible lesion under endoscopic examination after TURBT or in the bladder specimen after RC. Kaplan-Meier curves and log-rank tests assessed disease-free survival (DFS). Logistic and Cox regression analyses were performed to identify potential predictors.ResultsA total of 236 patients were included in this review, including 207 males, with a median age of 61 years. The median tumor size was 3 cm, and a total of 94 patients had identified pathological T2 stage disease. Complete TURBT was correlated with tumor size (p = 0.041), histological variants (p = 0.026), and down-staging (p < 0.001). Tumor size, grade, and histological variants were independent predictors of complete TURBT. During a median follow-up of 42.7 months, 30 patients developed disease recurrence. Age and histological variants were independent predictors of DFS (p = 0.022 and 0.032, respectively), whereas complete TURBT was not an independent predictor of DFS (p = 0.156). Down-staging was not associated with survival outcome.ConclusionsComplete TURBT was correlated with an increased rate of down-staging before RC. It was not associated with better oncologic outcomes for patients with organ-confined bladder cancer.     

The value of a second transurethral resection for T1 bladder cancer

OBJECTIVE: To evaluate a series of repeat transurethral resections (TURs) of tumour in patients with T1 bladder cancer, usually used to ensure a complete resection and to exclude the possibility muscle-invasive disease. PATIENTS AND METHODS: In all, 136 consecutive patients had a second TUR because of a histopathological diagnosis of T1 transitional cell carcinoma (TCC) after their initial TUR. Of the 136 patients, 101 were first presentations and 35 had recurrent tumours. The second TUR was done 4-6 weeks later. The evaluation included the presence of previously undetected residual tumour, changes to histopathological staging/grading, and tumour location. RESULTS: In all, 71 patients (52%) had residual disease according to findings from specimens obtained during the second TUR. The staging was: no tumour, 65 (48%); Ta, 11 (8%); T1, 32 (24%); Tis, 15 (11%); and > or = T2, 13 (10%). Histopathological changes that worsened the prognosis (>T1 and or concomitant Tis) were found in 21% of patients. Residual malignant tissue was found in the same location as the first TUR in 86% of the patients, and at different locations in 14%. Overall, 28 patients (21% of the original 136) had a radical cystectomy as a consequence of the second TUR findings. CONCLUSIONS: A routine second TUR should be advised in patients with T1 TCC of the bladder, to achieve a more complete tumour resection and to identify patients who should have a prompt cystectomy.