经尿道汽化电切术治疗浅表性膀胱肿瘤的临床观察（附120例报告）

目的探讨经尿道汽化电切术治疗浅表性膀胱肿瘤的手术方法和I临床疗效。方珐应用铲状汽化切割电极和滚状汽化电极对120例膀胱肿瘤患者进行汽化电切术（transurethralvaporizationofbladdertumor，TUVBt）及对膀胱黏膜进行次全汽化。对其中19例合并良性前列腺增生症（benignprostatiohyperplasia，BPH）者同期行经尿道前列腺汽化电切术（transurethralvaporizationoftheprostate，TUVP）。结杲120例均一次切除肿瘤。手术时间：单纯TUVBt者平均26min，同时行TUVP者平均50min。术中无大出血发生，膀胱穿孔致冲洗液外渗3例；93例获得随访，随访时间7—60个月，共15例复发，复发率16.13％。结论TUVBt操作简单、切割深度易掌握、手术创伤小、并发症少、疗效确切，同时行膀胱黏膜次全汽化，可能进一步降低肿瘤复发率。     

经尿道铲状电极汽化加电切术切除浅表性膀胱肿瘤的疗效观察

目的探讨治疗膀胱肿瘤的理想术式。方法采用经尿道铲状电极汽化加电切术治疗浅表性膀胱肿瘤60例,对侧壁肿瘤采用闭孔神经阻滞的方法有效地防止了闭孔神经反射导致的膀胱穿孔。结果术中无膀胱穿孔、无输尿管口损伤,出血较少,不需输血。术后无尿路感染及继发性膀胱破裂等并发症。所有病例经3~20个月随访,有3例于术后6、9、12个月复发,再次手术,未遗留其他并发症。结论经尿道铲状电极汽化加电切术治疗与单纯经尿道膀胱肿瘤切除术和单纯膀胱肿瘤电汽化相比,具有出血少、手术并发症发生率低等优点,是治疗膀胱肿瘤的最佳术式。     

经尿道汽化电切术治疗浅表性膀胱癌25例

目的探讨经尿道汽化电切术治疗浅表性膀胱肿瘤的疗效。方法对25例浅表性膀胱癌患者行经尿道汽化电切术治疗。结果23例膀胱肿瘤1次切除,2例较大的多发性膀胱肿瘤分2次切除,随访1-24个月,肿瘤复发6例。结论经尿道汽化电切术治疗浅表性膀胱肿瘤具有手术简单、损伤小、出血少、恢复快、疗效好等优点。     

2μm激光分层汽化切割膀胱术治疗膀胱肿瘤

目的 分析应用2 μm激光汽化切割术治疗膀胱肿瘤的临床疗效.方法 采用骶管麻醉,经尿道膀胱镜2μm激光汽化切割术治疗56例膀胱肿瘤患者,共切除肿瘤68个.术中分层汽化切割膀胱壁,逐层切除标本并分别送病理检查.观察手术时间,术中出血情况,术中及术后并发症.肿瘤病理分期以及术后随访等情况.结果 56例患者均可耐受手术;单个肿瘤平均治疗时间为7 min.本组患者手术时间4～15 min,平均(8.8±3.3)min;术中出血量极少,无闭孔神经反射,术后亦无继发出血,膀胱穿孔1例;术后肿瘤病理分期:T1期40例患者,共47个肿瘤,T2期16例患者,共21个肿瘤;术后随访12～17个月,平均14.5个月,复发3例,1例复发两次,总复发率5.3%.无原位复发.结论 2μm激光汽化切割术治疗膀胱肿瘤是一种安全有效的新方法.由于2μm激光可以做到对膀胱壁全层进行精细的分层汽化切除,不仅可以有效地治疗浅表性膀胱肿瘤,也适用于治疗部分浸润性膀胱肿瘤.     

经尿道电汽化术治疗浅表性膀胱癌

目的：探讨经尿道膀胱肿瘤电汽化术（TVBt）治疗浅表性膀胱移行细胞癌（TCC）的疗效。方法：对73例浅表性膀胱癌患者行TVBt术,其中12例合并良性前列腺增生症（BPH）者同时行经尿道前列腺电汽化术（TVP）。结果：72例膀胱肿瘤一次切除,1例多发性膀胱肿瘤分2次切除。平均手术时间TVBt为29min,TVBt TVB为78min,1例术中膀胱穿孔。全组无输血。术后平均留置尿管46h.73例均随访24个月,复发15例（21％）。结论：TVBt具有操作简便、止血效果好、汽化深度可靠、膀胱穿孔少及术后并发症低等优点。     

经尿道电汽化切除治疗浅表性膀胱肿瘤46例临床分析

目的:探讨经尿道电汽化切除治疗浅表性膀胱肿瘤的疗效。方法:对46例浅表性膀胱肿瘤患者行经尿道电汽人切除术(TVBt),其中6例合并良性前列腺增生症(BPH)同时进行经尿道前列腺电汽化切除手术(TVP)。结果:46例膀胱肿瘤均一次切除,1例术中膀胱穿孔,术后留至尿管平均24h,平均手术时间TVBt为25min,TVBt+TVP为76min,均未输血,术后36例均随访24个月,复发11例(14％),均为异位复。结论:TVBt具有操作简便,汽化深度可靠,止血效果好,损伤小,术后并发症少等优点。     

经尿道膀胱肿瘤电汽化术治疗浅表性膀胱肿瘤的临床观察

目的探讨经尿道膀胱肿瘤电汽化术(transurethral vaporization of bladder tumors ,TVBt)治疗浅表性膀胱肿瘤的效果. 方法对46例浅表性膀胱肿瘤行TVBt,其中3例合并良性前列腺增生(benign prostatic hyperplasia,BPH)同时行经尿道前列腺电汽化术(transurethral vaporization of prostate,TUVP),术后常规丝裂霉素及塞替派交替膀胱灌注. 结果 44例1 次切除,2例多发性肿瘤分2次切除.平均手术时间TVBt为35 min,TVBt联合TUVP为90 min.2例术中膀胱穿孔.全组无输血.46例均获随访24个月,复发10例(21.7%). 结论 TVBt具有操作简单,出血少,恢复快,汽化深度可靠,膀胱穿孔少及术后并发症低等优点.     

绿激光治疗浅表性膀胱肿瘤疗效评估及术后基底部病理初步研究

目的 应用绿激光治疗浅表性膀胱肿瘤31例,研究术后基底部病理情况,评估绿激光汽化切除浅表性膀胱肿瘤的可靠性、安全性、疗效和彻底性.方法 2010年3月至2010年10月,应用国产瑞尔通100W绿激光,经尿道治疗浅表性膀胱肿瘤患者31例,其中男性患者24例,女性患者7例,年龄37～80岁(平均67岁),16例患者患有不同程度的心肺脑疾病.所有病例术前均经CT检查和膀胱镜取活检,病理为浅表性肿瘤,病理分级G1～G2,分期Ta～T1.肿瘤单发24例,多发7例,肿瘤直径0.3～3.5 cm.并在行绿激光汽化肿瘤后,取肿瘤基底部活检并送病理.手术采用腰硬联合麻醉,每个肿瘤均汽化至见到膀胱壁呈网格结构.结果 本组31例患者均取得手术成功.手术时间10～40 min,平均20min,术中无明显出血,无闭孔神经反射、膀胱穿孔及术后继发性大出血等并发症.31例患者肿瘤汽化切除后基底部病理均未查见肿瘤细胞.术后留置导尿管1～3天,无1例需行膀胱冲洗,术后定期行丝裂霉素、吡柔比星或BCG等药物膀胱灌注.术后所有病例均定期随访,定期行膀胱镜检查(第1年每3个月1次,后根据肿瘤复发情况调整检查间隔),随访6～12个月,平均9个月,肿瘤复发2例,均为异位复发,复发率为6.5%.结论 绿激光治疗浅表性膀胱肿瘤疗效确切,其汽化切除深度可达膀胱壁深肌层甚至到包膜,可将所见肿瘤彻底汽化切除.同时绿激光治疗浅表性膀胱肿瘤具有操作简单,安全性高,术后并发症少等优点,伴有心肺脑疾病的老年患者同样适用.     

铲状电极经尿道气化治疗前列腺增生疗效观察(附68例报告)

目的：观察铲状电极经尿道气化切割治疗前列腺增生症（ＢＰＨ）的近期疗效。方法：应用铲状电极经尿道气化切割治疗ＢＰＨ６８例。结果：手术时间平均６５ｍｉｎ,术中平均失血６０ｍｌ,无电切综合征发生;切除前列腺组织重量平均１９ｇ。６４例随访１￣６个月,ＩＰＳＳ评分从术前２６．７分降至８．３分,最大尿流率从术前４．８ｍｌ／ｓ增加至１７．６ｍｌ／ｓ。结论：铲状电极经尿道气化切割技术具有气化和切割的双重作用,创面     

经尿道汽化术治疗浅表性膀胱肿瘤(附56例报告)

目的探讨经尿道汽化术治疗浅表性膀胱肿瘤的方法和疗效。方法回顾性分析采用经尿道汽化术治疗浅表性膀胱肿瘤患者56例。结果术后52例获得随访(92．9％)，平均21(6-36)个月，术后3个月内复发2例，3—6个月复发3例，6—12个月复发5例，12—24个月复发4例，24个月内复发率为26．9％(14／52)，无其他手术并发症发生。结论经尿道汽化术治疗浅表性膀胱肿瘤安全性高，易掌握，并发症少，疗效确切。     

The significance of random bladder biopsies in superficial bladder cancer

Introduction: Today, there is no consensus about taking random bladder biopsies during transurethral resection of superficial bladder tumors for staging and to determine the urothelial abnormalities like dysplasia and carcinoma in situ. The aim of our study was to evaluate the results and indications of random bladder biopsies for primary superficial bladder cancer.Patients and methods: Random bladder biopsies were taken from 84 patients with primary superficial bladder cancer after transurethral resection. 40 patients had Ta and 44 had T1 tumor. The random biopsies were taken from right and left bladder walls, anterior and posterior walls, dome, trigone and prostatic urethra. The incidence of urothelial abnormalities were evaluated according to the stage and grade of the tumor.Results: None of the patients had carcinoma in situ or dysplasia with Ta tumor. In T1 group, 4 patients (9.1%) had carcinoma in situ and 3 patients (6.8%) had dysplasia. There was a statistically significant difference with regard to urothelial abnormalities between groups Ta and T1. The same difference was also seen between low and high grade tumors.Conclusion: In our study, only 7/84 (8.3%) of patients with primary superficial bladder cancer had urothelial abnormalities like carcinoma in situ or dysplasia. All of these pathologies were seen in T1 tumors. According to our results, we believe that random biopsies are not useful in superficial bladder cancers to detect urothelial abnormalities and also do not help for the planning of further treatment.     

Long-term results of intravesical bacillus Calmette-Guérin therapy for stage T1 superficial bladder cancer

OBJECTIVES: To examine in a prospective study the incidence of recurrence and progression in patients with Stage T1 bladder carcinoma after complete transurethral resection of the bladder tumor and adjuvant immunotherapy with bacillus Calmette-Guérin (BCG). METHODS: Between July 1987 and April 1999, 126 patients presenting to our clinic with a superficial urothelial carcinoma of the bladder (Stage pT1, grade 1-3) received adjuvant intravesical immunotherapy with BCG after complete transurethral resection of the bladder tumor. In the case of recurrence of superficial tumor (pTa, pT1, or carcinoma in situ), patients received a second cycle of BCG. For muscle-invasive tumor progression (pT2, pT3, or pT4), radical cystectomy was recommended. Six of the patients (5%) presented with Stage pT1,G1 tumor, 74 (59%) with Stage pT1,G2 tumor, and 46 patients (36%) with Stage pT1,G3 tumor. Median follow-up was 53 months (range 3 to 144). RESULTS: One hundred eight patients (86%) remained tumor-free with a retained bladder during the follow-up after one or two 6-week cycles of BCG. Twenty-four patients (19%) had a recurrence of superficial tumor, 13 (10%) had muscle-invasive progression after the first BCG cycle, and an additional 4 (3%) had progression after the second BCG cycle. Six patients (5%) underwent radical cystectomy, and 9 patients (7%) died as a result of tumor progression. The tumor-free survival rate of all patients was 89% (112 of 126). CONCLUSIONS: Adjuvant immunotherapy with BCG after complete transurethral resection of the bladder tumor represents a highly effective primary treatment for Stage T1 carcinoma of the bladder. Even in Stage pT1,G3 tumor, immediate radical cystectomy does not appear necessary.     

Tumor recurrence in prostatic urethra following simultaneous resection of bladder tumor and prostate

A comparative retrospective study was performed on 100 patients who had undergone transurethral resection of a superficial bladder tumor (Ta-Tl) with no associated carcinoma in situ (group 1) and 100 patients who had undergone simultaneous transurethral resection of a superficial bladder tumor (Ta-Tl), with no associated carcinoma in situ, and benign prostatic hyperplasia (group II). Evaluation of the recurrences of prostatic urethral tumors in both groups showed that they appeared in 10 patients (12 recurrences) in group I and 10 patients (14 recurrences) in group II (p = not significant). These data enabled us to rule out the influence of simultaneous transurethral resection in cases of recurrences of prostatic urethral tumors.     

Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials

PURPOSE: We determine if intravesical bacillus Calmette-Guerin (BCG) reduces the risk of progression after transurethral resection to stage T2 disease or higher in patients with superficial (stage Ta, T1 or carcinoma in situ) bladder cancer. MATERIALS AND METHODS: A meta-analysis was performed of the published results of randomized clinical trials comparing transurethral resection plus intravesical BCG to either resection alone or resection plus another treatment other than BCG. RESULTS: We identified 24 trials with progression information on 4,863 patients. Based on a median followup of 2.5 years and a maximum of 15 years, 260 of 2,658 patients on BCG (9.8%) had progression compared to 304 of 2,205 patients in the control groups (13.8%), a reduction of 27% in the odds of progression on BCG (OR 0.73, p = 0.001). The percent of patients with progression was low (6.4% of 2,880 patients with papillary tumors and 13.9% of 403 patients with carcinoma in situ, reflecting the short followup and relatively low risk patients entered in many of the trials. The size of the treatment effect was similar in patients with papillary tumors and in those with carcinoma in situ. However, only patients receiving maintenance BCG benefited. There was no statistically significant difference in treatment effect for either overall survival or death due to bladder cancer. CONCLUSIONS: Intravesical BCG significantly reduces the risk of progression after transurethral resection in patients with superficial bladder cancer who receive maintenance treatment. Thus, it is the agent of choice for patients with intermediate and high risk papillary tumors and those with carcinoma in situ.     

经尿道电气化术治疗浅表性膀胱癌的疗效观察

目的：观察经尿道膀胱肿瘤电气化术（TVBt)治疗浅表性膀胱移行细胞癌（TCC）的治疗效果。方法：对62例浅表性膀胱癌患者行TVBt术，其中6例并发良性前列腺增生（BPH）者同时行经尿道前列腺电气化术（TVP），术后常规行丝裂霉膀胱灌注。结果：60例膀胱肿瘤1例切除，2例多发性膀胱肿瘤分两次切除。平均手术时间TVBt为31min，TVBt加TVP为82min。1例术中膀胱穿孔，全组无输血，术后平均留置尿管，48h。60例均随访24个月。复发14例（22%）。结论：TVBt具有操作简单，出血少，恢复快，术后并发症低等优点。     

Intravenous urography in patients with transitional cell carcinoma of the bladder. The incidence and implications of ureteral obstruction.

In order to study the value of excretory urography in the diagnosis of transitional cell carcinoma of the bladder, and also the incidence and implications of ureteral obstruction, 100 consecutive patients were studied. Of 73 patients with superficial tumours (stages Tis, Ta, T1) only 1 (1,4%) had hydronephrosis as a result of the bladder tumour. However, 2 further patients had hydronephrosis secondary to synchronous ureteral tumours. Of the 27 patients with muscle-invasive tumours, 10 (37%) had hydronephrosis at the time of diagnosis. Four patients who had normal upper tracts initially, developed hydronephrosis during follow-up: 1 due to progression of a superficial tumour to stage T3, 1 due to the development of an ureteral tumour, and 2 due to fibrosis of the intramural ureter after transurethral resection of superficial tumours. The presence of ureteral obstruction at the time of diagnosis most often implies a muscle-invasive tumour, but the possibility of a synchronous ureteral tumour must also be considered. Fibrous strictures of the distal ureter can occur after transurethral resection of superficial bladder tumours.     

Restaging transurethral resection of high risk superficial bladder cancer improves the initial response to bacillus Calmette-Guerin therapy

PURPOSE: This study was an evaluation of whether restaging transurethral resection (TUR) of superficial bladder cancer improves the early response to bacillus Calmette-Guerin (BCG) therapy. MATERIALS AND METHODS: A total of 347 patients with high risk superficial bladder cancer (high grade Ta and T1 tumors associated with carcinoma in situ) underwent a single transurethral resection (TUR, 132 patients) or restaging TUR (215 patients) before receiving 6 weekly intravesical BCG treatments. The patients were evaluated for response (presence or absence of tumor) at first followup cystoscopy, at 6 and 12 months after treatment, and evaluated for disease stage progression within 3 years of followup. RESULTS: Of the 132 patients who underwent a single TUR before BCG therapy, 75 (57%) had residual or recurrent tumor at the first cystoscopy and 45 (34%) later had progression, compared with 62 of 215 patients (29%) who had residual or recurrent tumors and 16 (7%) who had progression after undergoing restaging TUR (p = 0.001). CONCLUSIONS: Restaging TUR of high risk superficial bladder cancer improves the initial response rate to BCG therapy, reduces the frequency of subsequent tumor recurrence and appears to delay early tumor progression.     

Results of adjuvant intravesical Bacillus Calmette-Guérin therapy for grade 3 superficial bladder cancer

To examine the incidence of recurrence, progression and survival in patients with grade 3 superficial bladder cancer after transurethral resection (TUR) and adjuvant intravesical instillation of Bacillus Calmette-Guérin (BCG), we retrospectively studied 39 patients with grade 3 superficial bladder cancer. Nineteen patients with high-grade superficial bladder cancer (pTa, pT1) and 5 patients with grade 3 carcinoma in situ (CIS) received intravesical instillation of BCG after transurethral resection of the bladder tumor (BCG group and CIS-BCG group). The Tokyo 172 strain BCG was given for 8 weeks, as a rule, in a dose of 80 mg in 40 ml of saline instilled into the bladder. As a control, 15 patients with grade 3 superficial bladder cancer who did not receive BCG therapy after TUR were compared (non-BCG group). Of the BCG group (n=19), 4 patients (21.1%) had recurrent tumor and 3 had invasive progression after BCG therapy and died as a result of tumor progression, while in the non-BCG group (n=15), 8 cases (53.3%) developed recurrence, only one case had progression and died of cancer. In the CIS-BCG group (n=5), 3 patients (60.0%) had recurrent tumor and 2 had invasive progression. Univariate analysis (Logrank test) demonstrated that tumor size and adjuvant instillation of BCG were associated with tumor recurrence except for carcinoma in situ, but tumor progression and survival did not differ significantly. Our results suggest that BCG therapy prevents grade 3 superficial bladder cancer (pT1, pTa) recurrence.     

非麻醉下经尿道等离子电切术治疗浅表膀胱癌9例报道

目的:评价非麻醉下应用经尿道等离子电切术治疗浅表膀胱癌的可行性.方法:应用经尿道等离子电切术治疗浅表膀胱肿瘤,肿瘤直径<1 cm,不超过2个.结果:9例手术均成功,平均手术时间10 min,术中未出现闭孔神经反射、膀胱穿孔、大出血等并发症.结论:非麻醉下经尿道等离子电切术具有创伤小,时间短,恢复快,并发症少,费用低,安全有效等优点,适用于门诊推广.     

A large amount of distilled water ineffective for prevention of bladder cancer cell implantation at the time of transurethral resection

A previous study indicated that distilled water could prevent bladder tumor cell implantation in an in vitro assay. We investigated whether a large amount of distilled water irrigation prevented recurrence of superficial bladder cancer in the clinical setting and then we estimated whether cancer cell implantation at the time of transurethral resection is a major mechanism of recurrence. Between May 2000 and January 2002, 22 patients with primary, superficial bladder carcinoma who underwent transurethral resection of bladder tumors (TURBT) were enrolled in this study. The patients underwent bladder washout with 1,000 ml distilled water immediately after TURBT, and then intravesical irrigation with 3,000 ml water for three hours. Control patients were randomly chosen from those who previously underwent TURBT in our hospital and had similar prognostic factors. The 1- and 2-year recurrence-free rates in the patients undergoing distilled water irrigation were both 45% and those in the control patients were 65% and 45%, respectively. There were no significant differences between the two groups. This result indicates that distilled water was ineffective in preventing recurrence of superficial bladder tumor.