窄带显像膀胱镜引导经尿道膀胱肿瘤电切术在预防膀胱肿瘤术后复发中的应用价值

目的 探讨窄带显像膀胱镜(barriw band imaging,NBI)引导下经尿道膀胱肿瘤电切术在预防、降低膀胱肿瘤术后复发中的应用价值.方法 筛选2012年1月至2015年6月本院收治的非肌层浸润性膀胱肿瘤患者120例作为研究对象.根据患者治疗方式将其分为观察组与对照组,对照组63例患者采用常规白光下经尿道等离子电切术治疗,观察组57例患者则在NBI引导下型经尿道膀胱肿瘤电切术治疗,比较两组患者手术相关指标及临床预后结局.结果 120例患者均顺利完成手术.两组患者手术用时、尿管留置时间、住院时间以及术后并发症发生率比较差异无统计学意义(P>0.05);术后随访结果显示,对照组患者术后膀胱肿瘤复发率明显高于观察组(P<0.05),并且观察组平均无复发生存时间明显高于对照组(P<0.05).结论 NBI引导经尿道膀胱肿瘤电切术治疗膀胱肿瘤疗效确切,同时可有效降低术后患者肿瘤复发率,具有临床应用及推广价值.     

Smoking status is a risk factor for recurrence after transurethral resection of non-muscle-invasive bladder cancer

Background

Cigarette smoking is the most well-established risk factor for developing bladder cancer.

Objective

To investigate the role of smoking status on the clinical outcome of patients with non-muscle-invasive bladder cancer.

Design, setting, and participants

Data obtained during a prospective phase 3 study with three schedules of epirubicin were used for statistical analysis. Smoking status (obtained when entering the study), other prognostic variables, and clinical outcome measures of 718 patients were analyzed. Mean follow-up was 2.5 yr.

Measurements

The primary outcome measure was recurrence-free survival (RFS).

Results and limitations

Demographics were similar for nonsmokers versus ex-smokers and current smokers, except for gender (p < 0.001) and grade (p = 0.022). In univariate analyses, RFS was significantly shorter in male patients (p = 0.020), in patients with a history of recurrences (p < 0.003), in patients with multiple tumors (p < 0.004), in patients with a history of intravesical therapy (p = 0.037), and in ex-smokers and current smokers (p = 0.005). In multivariate analyses, a history of recurrences, multiplicity, and smoking status remained significant factors for predicting RFS. Gender and initial therapy were no longer a significant influence on RFS.Because progression was uncommon (n = 25) and follow-up was short and focused only on recurrences, no conclusion can be drawn on progression-free survival. A limitation of the study were the questionnaires. They were only used when entering the study, and there were no questions about passive smoking and other causal factors.

Conclusions

In this prospective study, the significance of known factors (history of recurrences and number of tumors) in predicting RFS was confirmed. Another significant factor that appears to predict RFS is smoking status: ex-smokers and current smokers had a significantly shorter RFS compared with nonsmokers.     

再次经尿道电切术治疗非肌层浸润性膀胱癌

目的 总结再次经尿道电切术(Re-TUR)治疗非肌层浸润性膀胱癌的疗效.方法 2004年3月至2008年8月共收治462例非肌层浸润性膀胱癌,男性350例,女性112例,年龄35～83岁.在初次经尿道电切术后根据肿瘤分期和分级,以及标本有无肌层组织进行评估,有125例患者在术后4～6周行Re-TUR,其中Ta期49例,T1期76例;低级别癌58例,高级别癌67例;T1期肿瘤标本内未见肌层组织30例.结果 125例非肌层浸润性膀胱癌患者行Re-TUR,34.4%(43/125)发现有肿瘤残留,其中35例肿瘤未侵犯肌层,Ta期15例,T1期20例;8例肿瘤侵犯肌层.高级别癌的肿瘤残留率较低级别癌高(P<0.05);初次电切标本中无肌层的肿瘤残留率较有肌层的高(P<0.05).12例(9.6%)患者在初次电切术时肿瘤分期被低估.Re-TUR术中发生膀胱穿孔6例,膀胱出血7例.随访3～56个月;Re-TUR发现肿瘤残留的患者,37.2%(16/43)复发,高于Re-TUR未发现肿瘤残留的患者(12.2%,P<0.05).结论 T1期、高级别或初次电切标本无肌层的非肌层浸润性膀胱癌患者术后4～6周应行Re-TUR.Re-TUR能提高分期的准确性.     

经尿道膀胱肿瘤电切加黏膜下注射吡柔比星及干扰素对浅表性膀胱癌复发的影响

目的：观察经尿道膀胱肿瘤电切加黏膜下注射吡柔比星及α-干扰素在减少浅表性膀胱癌复发中的作用.方法浅表性膀胱癌患者按入院先后次序随机分成两组,最后79例纳入研究,包括对照组42例,经尿道膀胱肿瘤电切后吡柔比星即刻膀胱灌注加维持膀胱灌注化疗;观察组37例,经尿道膀胱肿瘤电切后随即膀胱镜下行膀胱黏膜下吡柔比星、α-干扰素注射.对比两组患者术后肿瘤复发率、复发时间、拔除导尿管后尿频持续时间、发热及白细胞异常降低发生率等情况.结果所有患者全部顺利完成手术.随诊3年,对照组复发16例,复发率38.1％,平均复发时间7.4个月,发热2例.观察组复发7例,复发率18.9％,平均复发时间11.2个月,发热25例.两组患者术后肿瘤复发率、复发时间、发热发生率等方面差异有统计学意义;术后拔除导尿管后尿频持续时间两组差异无统计学意义;两组均无白细胞异常降低发生.结论经尿道膀胱肿瘤电切术加黏膜下注射吡柔比星及干扰素安全有效,可减少浅表性膀胱癌的术后复发.     

Evaluation of an unconventional treatment modality with mistletoe lectin to prevent recurrence of superficial bladder cancer: a randomized phase II trial

PURPOSE: The indication for topic chemotherapy or immunotherapy for well differentiated, noninvasive superficial bladder cancer remains controversial. Side effects of these treatments promoted use of unconventional therapies with cytokines, immunomodulators and mistletoe extracts. However, there are no controlled clinical data available on the efficacy of these extracts for bladder cancer. We evaluate the influence of subcutaneously applicated mistletoe lectin on bladder tumor recurrence after transurethral resection. MATERIALS AND METHODS: The study consists of 45 patients with pTa G1-2 bladder cancer treated with transurethral resection during a 3-year period. Median patient age was 65 years and 33 patients were male. The study cohort was randomly divided into a treatment group receiving adjuvant therapy with mistletoe lectin and a control group receiving no additional treatment. Patients in the treatment group received mistletoe lectin according to schedule 2 weeks after transurethral resection. Clinical followup was assessed 3, 6, 9, 12 and 18 months after the initial resection, and included uretherocystoscopy. RESULTS: Both study arms comprised similar patients with regard to total number of previous tumors (mean 2.6 versus 2.9), number of primary lesions (14 versus 12) and number of recurrent tumors (8 versus 11). After followup of 18 months the recurrence-free interval in both study arms was similar (p = 0.76) and the total number of recurrences comparable (p = 0.48). CONCLUSIONS: Subcutaneous use of mistletoe lectin as adjuvant treatment after transurethral resection does not seem to affect the time to first recurrence, total number of recurrences or recurrence-free outcome.     

Hexaminolevulinate-guided transurethral resection of non-muscle-invasive bladder cancer does not reduce the recurrence rates after a 2-year follow-up: a prospective randomized trial

Purpose

To assess the impact of hexaminolevulinate (HAL) on the long-term recurrence rate of NMIBC.

Methods

A total of 130 patients with bladder tumour were randomized into two groups. The patients in one group had a HAL instillation before surgery, and they first had a white-light and after that a blue-light cystoscopy (BL group) and resection. The second group had only white-light cystoscopy (WL group) and resection. They have been followed up with cystoscopy every 3 months for a period of up to 40 months.

Results

The recurrence-free period was not significantly different between the two groups (BL and WL groups) (long-rank test p = 0.202). The use of HAL helped detect four flat lesions and 28 papillary lesions with cancer that would have been missed under WL only, on 16 out of the 54 patients (29.6 % CI 95 % 11.1–33.3). The use of HAL changed the proposed postoperative treatment and follow-up for one out of the five patients.

Conclusions

Although the use of HAL cystoscopy identified at least one cancer lesion more than WL cystoscopy on one out of the three patients, the recurrence-free period was not significantly different.     

The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomized clinical trial

PURPOSE: We compared the outcomes of repeat transurethral resection plus intravesical mitomycin C with initial transurethral resection of bladder plus intravesical MMC in patients with newly diagnosed pT1 transitional cell carcinoma of the bladder in terms of recurrence, progression and overall survival. MATERIALS AND METHODS: Of 148 newly diagnosed patients with T1 bladder cancer 142 were prospectively randomized in 2 groups between January 2001 and January 2005. A total of 74 patients underwent second TURB and received adjuvant MMC intravesically (group 1) and 68 patients received adjuvant MMC following the initial TURB (group 2). All repeat TURB operations were performed 2 to 6 weeks following initial TURB. Patients with incomplete resection, Cis or muscle invasive disease were excluded from study. The first dose of mitomycin C (40 mg per week for a total of 8 weeks) was instilled intravesically in all patients during the first 24 hours after the last surgery. RESULTS: Mean followup was 31.5 months (range 6 to 48) with no difference between the 2 groups. The rate of recurrence-free survival was 86.35% (SE 0.4%), 77.67% and 68.72% in group 1, and 47.08%, 42.31% and 37.01% in group 2 for the first, second and third year, respectively (overall 74.32% vs 36.76%, log rank 0.0001). Recurrence was observed in 19 of the 74 (25.68%) patients in group 1 and in 43 of the 68 (63.24%) patients in group 2. Ten of the 19 (52.63%) patients in group 1 and 35 of the 43 (81.39%) patients in group 2 had recurrence within 12 months. Recurrence was observed in 17.6%, 25% and 60% of patients with G1, G2 and G3 tumors, respectively, in group 1. The same rates for group 2 were 25%, 64% and 90%. The RFS rate was significantly worse in the high grade group (G2 and G3) (p <0.001). Progression was observed at 4.05% for group 1 compared to 11.76% for group 2 (log rank 0.0974). OS was 91.89% and 89.71% in group 1 and 2, respectively (log rank 0.732). CONCLUSIONS: The high recurrence rate in patients who did not undergo ReTUR is due to a high residual tumor rate following initial TURB. The benefit of ReTUR is especially true for high grade tumors. Since intravesical MMC was present in both groups, this study has shown that intravesical chemotherapy does not compensate for inadequate resection. Progression does not seem to be affected by ReTUR although there was a trend favoring the ReTUR group. We recommend ReTUR for patients with primary high grade T1 disease to achieve better recurrence-free survival.     

荧光膀胱镜下膀胱肿瘤电切术治疗非肌层浸润性膀胱癌的效果观察

目的 观察荧光膀胱镜下膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)治疗非肌层浸润性膀胱癌的临床效果.方法 57例非肌层浸润性膀胱癌患者根据所使用的膀胱镜的不同分为两组:白光膀胱镜组(n=30),采用白光膀胱镜下TURBT治疗;荧光膀胱镜组(n=27),采用荧光膀胱镜下TURBT治疗.比较两组的临床一般资料、手术相关指标及术后3、6、12及18个月不同时间点的复发率.结果 两组患者在性别、年龄、肿瘤数目、病理分期及病理分级等方面比较,差异无统计学意义(P>0.05);两组患者的手术时间、术中出血量、留置导管时间及术后住院时间等手术相关指标比较,差异亦无统计学意义(P>0.05);荧光膀胱镜组术后3、6、12及18个月不同时间点的复发率均明显低于白光膀胱镜组(P<0.05). 结论 荧光膀胱镜下TURBT治疗非肌层浸润性膀胱癌可明显降低术后早期复发率.     

经尿道电切镜下电凝+含切法切除侧壁膀胱肿瘤的疗效分析

目的 探讨经尿道电切镜下电凝+含切法切除侧壁膀胱肿瘤在应对闭孔神经反射的作用. 方法 对我院2010年3月至2016年6月收治的114例侧壁膀胱肿瘤行经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor, TURBT)患者的资料进行回顾性分析,按照不同的手术方式将患者分成两组:A组应用常规的TURBT方法切除膀胱肿瘤(56例),B组采用电凝+含切的方法切除肿瘤(58例).对闭孔神经反射发生率、手术时间、留置导尿管时间、术后膀胱冲洗时间、住院时间、膀胱破裂穿孔发生率及术后半年复发等进行统计学分析. 结果 A组术中发生闭孔神经反射48例(严重闭孔神经反射发生34例),其中13例出现膀胱穿孔,中转全麻14例,中转开放手术5例;B组术中发生闭孔神经反射42例(严重闭孔神经反射发生11例),其中2例出现膀胱穿孔,中转全麻1例,中转开放手术1例.A、B组间在严重闭孔神经反射发生例数、膀胱穿孔例数、中转全麻例数、中转开放手术例数方面比较,差异均有统计学意义(P<0.05);A、B组在术后膀胱冲洗时间、留置导尿管时间、住院时间、术后半年肿瘤复发等方面差异均无统计学意义(P>0.05). 结论 经尿道电切镜下电凝+含切法切除侧壁膀胱肿瘤可以有效减少严重闭孔神经反射导致的膀胱破裂发生率.     

膀胱镜下膀胱肿瘤激光切除术与电切术的临床疗效对比研究

目的:探讨膀胱镜下膀胱肿瘤激光切除术与电切术的临床疗效及安全性。方法:选择2012年11月至2014年8月行膀胱肿瘤激光切除或电切术的163例患者,其中85例行激光切除术(激光组),电切组78例,对比分析两组手术时间、术中出血量、并发症发生率、术后导尿管留置时间、术后住院时间及随访情况。结果:163例均顺利完成手术,激光组与电切组手术时间[(24.2±2.4)min vs.(29.7±2.4)min]、术后留置导尿管时间[(2.83±0.96)d vs.(3.19±0.91)d]差异有统计学意义(P<0.001),激光组闭孔神经反射发生率低于电切组,术中出血量[(19.5±3.7)mL vs.(26.5±2.3)mL]低于电切组。两组患者术后均随访36个月,Kaplan-Meier生存曲线显示两组无瘤生存率差异无统计学意义(P=0.406),术后3年总体复发率差异无统计学意义。结论:与传统膀胱肿瘤电切术相比,激光切除的手术时间短,并发症发生率低,可作为膀胱镜下膀胱肿瘤切除术安全、可靠的替代术式,并且激光切除术可获取完整的术后病理组织,对于判断预后及后续治疗方案的制定具有重要作用。     

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。     

Perioperative single dose instillation of epirubicin or interferon-alpha after transurethral resection for the prophylaxis of primary superficial bladder cancer recurrence: a prospective randomized multicenter study--FinnBladder III long-term results

PURPOSE: We evaluated the long-term efficacy of a single dose of interferon or epirubicin administered immediately after transurethral resection compared with transurethral resection alone for primary superficial bladder cancer recurrence. MATERIAL AND METHODS: A total of 200 patients with primary superficial stages Ta to T1, grades 1 to 3 bladder cancer were randomized into 3 treatment groups, including transurethral resection alone, transurethral resection plus 50 milliunits interferon-alpha2b and transurethral resection plus 100 mg. epirubicin. The primary end point was time to first recurrence. RESULTS: At a median followup of 72 months we observed a sustained effect of a single epirubicin instillation compared with other treatments. To date only 46% of the patients in group 3 have experienced recurrence in contrast to 73% and 68% in groups 1 and 2, respectively (p = 0.002). At 72 months the Kaplan-Meier disease-free estimates were 24%, 31% and 51% in groups 1 to 3, respectively (p = 0.002). The Cox multivariate model revealed a more than 2-fold relative risk of recurrence in group 1 versus group 3 (p <0.001). Other significant variables predicting recurrence were grade and the number of tumors. CONCLUSIONS: A single perioperative instillation of 100 mg. epirubicin causes a significant and sustained decrease in primary superficial bladder cancer recurrence, whereas a single dose of 50 milliunits interferon-alpha2b is ineffective for prophylaxis.     

海博刀经尿道内镜黏膜下膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌的疗效

目的 探讨应用海博刀经尿道内镜黏膜下膀胱肿瘤整块切除术（ERBT）治疗非肌层浸润性膀胱癌（NMIBC）的临床疗效。方法 选取本院2019年3月至2021年1月收治的128例NMIBC患者作为研究对象,按照随机数字表法分为ERBT组和经尿道膀胱肿瘤电切术（TURBT）组,每组各64例。比较两组手术相关指标、术后并发症以及复发情况。结果 ERBT组患者的膀胱冲洗时间、尿管留置时间和术后住院时间均短于TURBT组(均P<0.05)。ERBT组患者的术后出血、闭孔神经反射、膀胱穿孔的发生率均低于TURBT组(均P<0.05)。ERBT组的逼尿肌检出率为98.4%(63/64),TURBT组的逼尿肌检出率为62.5%(40/64),两组差异有统计学意义(P<0.05)。随访18个月,ERBT组术后6个月、6～12个月、12～18个月的复发率低于TURBT组,差异均有统计学意义(均P<0.05)。ERBT组患者的总复发率为6.3%（4/64）,TURBT组的总复发率为21.9%（14/64）,两组差异有统计学意义(P<0.05)。结论 应用海博刀经尿道内镜黏膜下ERBT治疗NMIBC安全有效,能明显降低术后复发率,值得临床推广应用。     

经尿道1.9μm激光切除术与经尿道电切术治疗浅表性膀胱癌的疗效及安全性比较

目的 比较经尿道1.9 μm激光切除术与经尿道电切术治疗浅表性膀胱癌的疗效与安全性.方法 对北京协和医院泌尿外科2013年1月-2015年12月收治的53例浅表性膀胱癌患者,分别采用经尿道1.9 μm激光切除术(n=25)和经尿道电切术(n=28)治疗.比较两组手术时间、术中出血量、术后留置尿管时间、术后住院时间以及并发症发病率和肿瘤复发情况.结果 1.9 μm激光切除术组患者术中出血量为[(21.6±4.6) min]、术后留置尿管时间为[(22.4±6.4)h]、术后住院时间为[(2.2 ±0.7)d]、术后并发症发病率(12％)及术后复发率(16％)均低于经尿道电切术组,差异有统计学意义(P＜0.05).结论 经尿道1.9 μm激光切除术治疗浅表性膀胱癌具有安全、有效、并发症少、复发率低等特点,值得临床推广.     

Computer-assisted cystoscopy diagnosis of bladder cancer

Objectives

One of the most reliable methods for diagnosing bladder cancer is cystoscopy. Depending on the findings, this may be followed by a referral to a more experienced urologist or a biopsy and histological analysis of suspicious lesion. In this work, we explore whether computer-assisted triage of cystoscopy findings can identify low-risk lesions and reduce the number of referrals or biopsies, associated complications, and costs, although reducing subjectivity of the procedure and indicating when the risk of a lesion being malignant is minimal.

侵犯输尿管口型膀胱癌电切术中放置输尿管支架的技术改良

目的 研究改良后的经尿道膀胱肿瘤电切术术中放置输尿管支架技术的有效性和安全性.方法 共选取首都医科大学附属北京友谊医院泌尿外科于2014年3月-2016年6月收治的侵犯输尿管管口的肌层浸润性膀胱癌患者17例,利用随机数字表法将患者分为两组:(1)改良组(A组,10例),将输尿管开口部位的肿瘤切至膀胱肌层暴露输尿管开口后,利用电切镜电切襻通道放置输尿管支架管;(2)对照组(B组,7例),同法暴露输尿管开口后,换用普通膀胱镜进行输尿管支架管置入.观察两组患者人口学及肿瘤学基线情况以及相关手术指标,利用t检验、秩和检验和Fisher精确检验对两组数据进行对比研究.结果 A、B两组间肿瘤分期、分级以及最大直径等方面差异均无统计学意义(P＞0.05).手术时间A组明显短于B组[分别为(39.5±14.8) min和(59.3±16.2)min,P=0.020)],术中视野清晰度评分A组明显优于B组[分别为(7.7±1.3)分和(5.9±1.2)分,P=0.010)].手术效果及并发症发病率方面两组之间差异无统计学意义.结论 通过电切镜直接置管法,可以有效提高经尿道膀胱肿瘤电切术中电切输尿管口后放置输尿管支架管的效率,且不增加手术风险.     

非肌层浸润性膀胱癌患者术前是否需要常规行IVU检查

目的 探讨非肌层浸润性膀胱癌患者术前是否需要常规行IVU检查.方法 病理确诊为非肌层浸润性膀胱癌患者1968例.男1021例,女947例.年龄16～84岁,平均57岁.病理分期均为Ta～T1,细胞分级G11541例、G2382例、G345例.术前均行双肾输尿管膀胱超声、膀胱镜、IVU检查.均行经尿道膀胱肿瘤切除术.统计学比较分析不同检查方法上尿路癌的检出率.结果 1968例患者中同时发生上尿路癌216例(11.0%).1582例血尿者IVU检查发现上尿路癌215例(13.6%),386例偶然发现膀胱癌患者IVU检查发现上尿路癌1例(0.3%),有无血尿者IVU检查发现上尿路癌比例差异有统计学意义(P＜0.01).超声检查示上尿路异常者120例IVU检查均发现上尿路癌(100.0%),1848例超声检查上尿路无异常者IVU检查发现96例(5.2%),组间比较差异有统计学意义(P＜0.01);1247例超声检查上尿路无异常的单发肿瘤患者IVU检查发现上尿路癌37例(3.0%),601例多发者IVU检查发现59例(9.8%),组间比较差异有统计学意义(P＜0.01);超声检查上尿路无异常的单发膀胱肿瘤直径＜1.0 cm者IVU检查发现上尿路癌2例(0.2%),肿瘤直径≥1.0 cm者IVU检查发现35例(8.2%),组间比较差异有统计学意义(P＜0.01).G1患者同时发生上尿路癌48例(3.1%),G2～G3168例(39.3%),组间比较差异有统计学意义(P＜0.01).结论 非肌层浸润性膀胱癌患者中有血尿症状、超声检查上尿路异常者、超声检查上尿路未见异常的膀胱肿瘤多发或单发但直径≥1.0 cm者、膀胱镜检查肿瘤可疑高级别者应行IVU检查;偶发病例、单发肿瘤且直径＜1.0 cm、肿瘤低级别者,术前可不行IVU检查.

Abstract：

Objective To discuss the need for performing intravenous urography(IVU) in patients with non-muscle invasive bladder cancer before surgery. Methods From 1997 to 2008,1968patients were diagnosed as non-muscle invasive carcinoma of the bladder with pathological confirmation. All patients underwent ultrasonography, cystoscopy and IVU prior to surgrey. The x2 test was used for statistical analysis. Results The incidence of upper urinary tract urothelial tumors (UUTUT) was 11. 0% (216 cases). Two hundred and fifteen (13. 6%) suffered simultaneous UUTUT detected by IVU in 1528 patients with bladder cancer who had intermittent painless gross hematuria, while only 1 (0.3 %) suffered simultaneous UUTUT in 386 non-symptomatic patients (P＜0.01). Among 120 patients with bladder cancer whose upper tract was abnormal detected by ultrasonography,120 (100. 0%) suffered simultaneous UUTUT detected by IVU, and of 1848 patients who were normal in upper tract by ultrasonography, 96 (5. 2%) suffered simultaneous UUTUT detected by IVU (P＜0. 01). Of the patients with no abnormalities in upper tract by ultrasound, 37(3. 0%) suffered simultaneous UUTUT detcted by 1VU in 1247 patients with single bladder tumor,and 59 (9.8%) suffered simultaneous UUTUT in 601 patients with multiple bladder tumors (P＜0.01). Of the patients with single bladder tumor who had no abnormalities in upper tract by ultrasonography, 2 (0.2%) suffered simultaneous UUTUT detected by IVU in 822 patients with the diameter of the tumor＜1.0 cm, and 35 (8. 2 %) suffered simultaneous UUTUT in 425 patients with the diameter≥1. 0 cm (P＜0.01). Of the 1541 patients with histological G1, 48 (3.1%) suffered simultaneous UUTUT detected by IVU, and of the 427 patients with histological G2- G3, 168 (39. 3%)suffered simultaneous UUTUT (P ＜ 0. 01 ). Conclusion Patients with the following characters should undergo IVU before surgery: hematuria, abnormal upper urinary tract by ultrasonography,multifocal tumours, the diameter of the single bladder tumor≥1. 0 cm and high gradc tumors.     

表浅膀胱肿瘤电切术后膀胱内药物灌注预防肿瘤复发的临床观察

目的 观察表浅膀胱肿瘤电切术后膀胱内灌注丝裂霉素和吡柔比星预防肿瘤复发的疗效和安全性.方法 回顾性分析我科2007年2月至2009年10月间收治的130例表浅膀胱肿瘤患者的临床资料,所有患者均行经尿道膀胱肿瘤电切和术后膀胱内灌注丝裂霉素或吡柔比星,其中术后膀胱内灌注丝裂霉素70例,吡柔比星60例.观察术后1年肿瘤复发和灌注药物的副作用.结果 ①术后膀胱内灌注丝裂霉素和吡柔比星的1年复发率分别为11.4%（8/70）和16.7%（10/60）（P＞0.05）.在丝裂霉素组,病理分级G1、G2、G3级肿瘤1年复发率分别为12.2%、8%和25%,它们之间无显著差异（P＞0.05）;在吡柔比星组,病理分级G1、G2、G3级肿瘤1年复发率分别为4%、12.5%和54.5%,其中G3级肿瘤复发率明显高于G1和G2级肿瘤（P＜0.05）.②130例患者中,进行即刻膀胱内药物灌注（24h内）和非即刻灌注的1年复发率分别为4%（1/25）和16.2%（17/105）,两者之间有显著性差异（P＜0.05）.③灌注丝裂霉素和吡柔比星后全身副作用发生率分别为18.5% 和 1.5%（P＜0.05）,局部副作用发生率分别为4.3% 和 33.3%（P＜0.05）.结论 术后膀胱内灌注丝裂霉素和吡柔比星预防肿瘤复发的效果无显著性差异,但G3级肿瘤的复发率高于G1和G2级肿瘤,对其灌注方案有待进一步研究;术后即刻膀胱内药物灌注可有效降低肿瘤1年复发率,值得推广;术后膀胱内灌注丝裂霉素和吡柔比星的副作用在全身和局部发生率不同,但均可耐受;由于观察时间短和例数有限,观察结果有待进一步研究.