经尿道膀胱肿瘤切除术后补救性动脉介入化疗治疗肌层浸润性膀胱癌的疗效分析

目的：探讨补救性髂内动脉化疗存经尿道膀胱肿瘤切除术（transurethralresectionofbladdertumor,TURBT）后证实为肌层浸润性膀胱癌患者中的治疗价值。方法：对34例TURBT患者术后基底部活检及病理结果证实为肌层浸润性的膀胱肿瘤患者行补救性髂内动脉化疗3次。方案为顺铂80mg、表柔吡星50mg、5-氟尿嘧啶1g（或羟基喜树碱30mg）。观察患者肿瘤复发率,Kaplan—Meier法计算总体生存率,肿瘤特异性生存率,无肿瘤复发生存率,并绘制生存曲线。结果：术后经3次补救性髂内动脉化疗及常规膀胱灌注后,29例患者得到保留膀胱（保留膀胱率85．3％）,肿瘤复发13例（肿瘤复发率38．2％）。其中,浅表性复发7例,行TURBT治疗;浸润性复发5例,行全膀胱切除术;骨转移l例,行全身化疗。总体生存率：3年69．78％,5年62．03％。肿瘤特异性生存率：3年77．43％,5年68．83％。无肿瘤复发生存率：1年93．10％,2年70．23％．3年46．82％。结论：补救性动脉介入化疗是TuRBT术后基底部活检及病理结果证实为肌层浸润性的膀胱肿瘤的良好选择。     

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.     

第二次经尿道膀胱肿瘤电切术预防高危非肌层浸润性膀胱癌术后肿瘤复发的临床研究

目的 探讨高危非肌层浸润性膀胱癌患者行二次经尿道膀胱肿瘤电切(TURBT)术的意义.方法 已行第一次TURBT的高危非肌层浸润性膀胱癌患者70例随机分为对照组和二次TURBT:对照组患者在电切术后行膀胱内化疗药物(丝裂霉素C)灌注治疗;二次TURBT组完成对照组治疗,术后3个月第一次复查时行第二次TURBT为实验组.两组患者随访2年,观察肿瘤复发的情况.结果 2年内实验组患者膀胱肿瘤的复发率相比对照组患者的复发率显著降低(P<0.05).结论 第二次TURBT术能有效降低高危非肌层浸润性膀胱癌患者术后肿瘤复发率.     

老年高危非肌层浸润性膀胱癌患者TURBt后即刻吉西他滨膀胱热灌注与常温灌注化疗的临床观察

目的:探究经尿道膀胱肿瘤电切术(TURBt)后即刻吉西他滨膀胱热灌注化疗与常温膀胱灌注化疗对老年高危非肌层浸润性膀胱癌患者的疗效。方法:选取2013年8月～2015年8月北京老年医院收治的老年高危非肌层浸润性膀胱癌患者84例,采用随机数字表的方法将研究对象分为观察组(42例)和对照组(42例),所有患者均行TURBt。观察组术后6h内行即刻吉西他滨膀胱热灌注;然后行长期膀胱热灌注;对照组术后6h内行吉西他滨常温膀胱灌注,而后行常规膀胱灌注化疗;随访比较两组患者的肿瘤复发率和不良反应发生情况。结果:全部病例随访24个月,观察组膀胱癌复发率低于对照组(P0.05),观察组总不良反应发生率与对照组比较差异有统计学意义(42.86%vs.95.24%,P0.05)。结论:TURBt后即刻吉西他滨膀胱热灌注化疗是预防老年高危非肌层浸润性膀胱癌患者术后复发的有效方法。     

术后即刻+短程膀胱灌注方案预防非浸润性膀胱癌术后复发应用体会

目的探讨运用术后即刻及短程膀胱灌注方案预防非浸润性膀胱癌术后复发的疗效。方法对丹阳市人民医院及复旦大学附属华山医院泌尿外科自2012年至2015年收治的39例(I组)病理证实为非浸润性膀胱癌行经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBt)的患者,术后用蒸馏水膀胱内冲洗后,即刻将40mg吡柔比星溶于40ml蒸馏水进行灌注,维持2小时后排出,术后7天开始规律每周1次共灌注8周,每月1次维持灌注8个月后结束。2012年之前的非浸润性膀胱癌患者45例(Ⅱ组),术后7天始同剂量吡柔比星规律常规膀胱灌注,每周1次共灌注8周,每月1次维持灌注12个月。比较Ⅰ、Ⅱ组患者膀胱肿瘤复发率、不良反应。结果二组进行常规膀胱镜复查随访,随访8~56个月,平均35.9个月,Ⅰ组4例膀胱肿瘤复发,Ⅱ组13例复发,差异有统计学意义;不良反应包括肉眼血尿及尿路刺激征等,两组相比较差异具有统计学意义。结论非浸润性膀胱癌TURBt术后运用优化的膀胱灌注方案(即刻+短程使用吡柔比星)灌注化疗,可以显著降低膀胱肿瘤复发率,减轻不良反应,在中低危非肌层浸润性膀胱癌患者中优点尤其明显,可作为推荐方案使用。     

软性膀胱镜下铥激光切除治疗非肌层浸润性膀胱癌18例分析

目的 评价软性膀胱镜下铥激光切除治疗非肌层浸润性膀胱癌的疗效及安全性.方法 本组18例,均经病理证实为非肌层浸润性膀胱癌, 共有肿瘤22枚,直径平均1.5 cm(0.5～3.0 cm).所有患者均在喉罩麻醉下行软性膀胱镜下铥激光肿瘤切除.术后常规丝裂霉素膀胱灌注化疗,定期行膀胱镜检查.结果 18例患者全获随访,平均随访1年(3～18个月),平均手术时间30 min(20～40 min),术中无膀胱穿孔等并发症;4例多发肿瘤患者术后需膀胱冲洗;所有患者均获得肿瘤分期;无尿道狭窄;复发3例,包括异位复发2例,原位复发1例.结论 软性膀胱镜下铥激光切除治疗非肌层浸润性膀胱癌具有损伤小、无手术盲区、无闭孔神经反射,切割精确等优点,可作为非肌层浸润性膀胱癌的有效治疗方式之一,尤其适合一些特殊情况下的经尿道膀胱肿瘤切除术.缺点是对于体积较小的肿瘤难以获得术后病理.     

肌层浸润性膀胱癌保留膀胱手术后不同辅助治疗方法的疗效评价

目的探索保留膀胱手术＋动脉灌注化疗＋膀胱内灌注化疗治疗肌层浸润性膀胱癌的临床疗效。方法对经尿道膀胱肿瘤电切或膀胱部分切除术后确诊为肌层浸润性膀胱癌（T2N0M0）的168例患者,充分向患者及其家属介绍病情和治疗建议,对拒绝或不适合膀胱全切的患者经患者及其家属同意,均采用保留膀胱治疗方法,分为3个治疗组：（1）综合治疗组：68例,术后采用动脉灌注化疗＋膀胱灌注化疗;（2）动脉灌注化疗组：48例,术后仅采用动脉灌注化疗;（3）膀胱灌注化疗组：52例,术后仅采用膀胱灌注化疗。结果168例膀胱癌（T2N0M0）患者,观察期内,综合治疗组患者中92．65％（63／68）无复发及转移,7．45％（5／68）分别在术后6、8、12、18、20个月复发,2．94％（2／68）在术后6、13个月出现全身多处转移死亡,11．76％（8／88）非膀胱癌导致死亡。动脉灌注化疗组患者中79．17％（38／48）无复发及转移,20．83％（10／48）在术后1～28个月复发,4．17％（2／48）在术后9、18个月出现全身多处转移死亡,12．50％（6／48）非膀胱癌导致死亡。膀胱灌注化疗组患者中44．23％（23／52）无复发及转移,55．77％（29／52）在术后1～24个月复发,15．38％（8／52）在术后10～96个月转移而死亡,13．46％（7／52）非膀胱癌导致死亡。3组疗效按复发率任何两组间比较,均有统计学差别（P均〈0．05）。3组疗效按癌性死亡率任何两组间比较,综合治疗组与动脉灌注化疗组相比,差异无统计学意义（P均〉O．05）;综合治疗组、动脉灌注化疗组均低于膀胱灌注化疗组,差异均有统计学意义（P均〈O．05）。3组患者分组治疗后非膀胱癌导致死亡率任何两组间比较,无统计学差异（P均〉o．05）。结论肌层浸润性膀胱癌（T2N0M0）患者,采用保留膀胱手术＋髂内动脉灌注化疗＋膀胱内灌注化疗的综合治疗方法,能有效减少肿瘤复发、预防转移、提高患者的生活质量,患者易于接受,值得进一步探讨。     

两种经尿道膀胱肿瘤切除术治疗非肌层浸润性膀胱癌的疗效比较

目的：比较非肌层浸润性膀胱癌的两种经尿道膀胱肿瘤切除手术治疗效果。方法将71例非肌层浸润性膀胱癌患者随机分为两组,分别采用经尿道钬激光切除术（ HoLRBT,n ＝33例）和等离子电切术（ TURBT,n＝38例）治疗,比较两组疗效。结果两组患者手术时间、术后住院天数、复发率、治愈率比较,差异无统计学意义（ P ＞0．05）;但HoLRBT组术中出血量、闭孔神经反射、膀胱穿孔、术后低钠血症发生率明显低于TURBT组,差异有统计学意义（ P ＜0．05）。结论较之 TURBT,HoLRBT在治疗非肌层浸润性膀胱癌方面具有安全、有效、并发症少等特点,优势明显。     

根治性经尿道膀胱肿瘤电切术加化疗治疗肌层浸润性膀胱癌的疗效分析

目的 探讨根治性经尿道膀胱肿瘤电切术(TURBt)加化疗治疗肌层浸润性膀胱癌的临床疗效. 方法 术前经CT及膀胱镜检查确诊为肌层浸润性膀胱癌不能耐受或拒绝行根治性膀胱切除术的患者32例,肿瘤最大直径1～5 cm,平均3 cm.临床分期:T2a期20例,T2b期12例.病理分级:G2 13例,G3 19例.采用根治性TURBt切除肿瘤至膀胱壁外脂肪层,范围至肿瘤基底部周围1 ～2 cm正常膀胱黏膜.术后常规行多西他赛75 mg/m2+奥沙利铂130 mg/m2静脉化疗,羟喜树碱20 mg+生理盐水20 ml膀胱灌注治疗.定期复查膀胱镜检查观察肿瘤复发情况. 结果 32例手术顺利.手术时间15 ～70 min,平均55 min;出血量10～150 ml,平均33 ml;术中术后未发生较严重并发症.术后病理报告均为移行细胞癌.32例化疗后出现骨髓抑制引起白细胞降低8例,肌肉注射重组人粒细胞集落刺激因子后好转;出现低热、轻微恶心、头痛3例,休息2～3d后好转.术后随访3～60个月,平均28个月.术后1年复发率9.4％(3/32),2年复发率12.5％(4/32).复发病例中T2a期4例,T2b期3例.死亡12例,5例死于膀胱癌转移.无瘤存活20例. 结论 根治性TURBt加化疗可作为经过选择的肌层浸润性膀胱癌的一种有效的治疗方法.     

不同药物膀胱灌注化疗对膀胱癌术后复发的影响

目的探讨不同药物膀胱灌注化疗对膀胱癌术后复发的疗效差异。方法 95例符合入选标准的非肌层浸润性膀胱尿路上皮癌患者,经尿道膀胱肿瘤电切术后被随机分为3组行早期加维持性膀胱内灌注：羟基喜树碱（HCPT）组31例;丝裂霉素（MMC）组32例;顺铂（DDP）组32例。随访2年,观察有无复发。结果 95例术后随访2年。HCPT组31例中9例复发,复发率29.0%;MMC组32例中10例复发,复发率31.3%;DDP组32例中10例复发,复发率31.3%,各组间复发率差异无统计学意义（P〉0.05）。结论 HCPT、MMC、DDP膀胱灌注化疗均能达到降低肿瘤复发的疗效。     

Fluorescence endoscopy with 5-aminolevulinic acid reduces early recurrence rate in superficial bladder cancer

PURPOSE: Several investigators have demonstrated an approximately 20% higher tumor detection rate by 5-aminolevulinic acid (ALA) fluorescence endoscopy compared to standard white light cystoscopy, and suggested a reduction in tumor recurrences when fluorescence endoscopy was performed as standard procedure during transurethral resection. We test this hypothesis. MATERIALS AND METHODS: In a prospective randomized multicenter study 102 patients underwent transurethral resection of bladder tumor(s) either with white light or ALA fluorescence assisted endoscopy. A second look transurethral resection with ALA fluorescence endoscopy was performed 6 weeks after the initial operation. RESULTS: At second look transurethral resection tumor was detected in 20 of 51 patients (39%) in the white light group and in 8 of 51 (16%) in the ALA fluorescence endoscopy group. This difference was statistically significant (p = 0.005). CONCLUSIONS: ALA fluorescence endoscopy is an innocuous and inexpensive diagnostic procedure that significantly improves bladder tumor detection rates compared to standard white light endoscopy. In our controlled study ALA fluorescence endoscopy reduced the residual tumor detection rate at second look transurethral resection by 59%.     

5-ALA诱导荧光膀胱镜下膀胱肿瘤电切除术(附31例报告)

目的:探讨5-ALA诱导荧光膀胱镜下膀胱肿瘤电切治疗的彻底性.方法:对31例血尿患者在5-ALA诱导荧光染色膀胱镜下行活组织检查及电切术.结果:31例呈荧光阳性,其中26例经术后病理证实为尿路上皮癌,5例为良性病变.其中11例移行细胞癌患者在癌旁或远处发现普通膀胱镜下无法识别的微小荧光阳性区域,经活检均证实有肿瘤存在.对该区域均在荧光指示下进行电切或电灼术.结论:5-ALA诱导荧光膀胱镜检对膀胱肿瘤诊断高度敏感,能发现微小及癌旁肿瘤,在荧光指示下能彻底切除肿瘤,减少复发.     

Long-term benefit of 5-aminolevulinic acid fluorescence assisted transurethral resection of superficial bladder cancer: 5-year results of a prospective randomized study

PURPOSE: As shown in various studies 5-aminolevulinic acid (ALA) induces fluorescence of malignant and dysplastic bladder tissue and increases tumor detection rates by about 20%. However, data on the long-term benefits are sparse. Thus, the 5-year outcome data of a prospective randomized trial comparing patients who initially underwent bladder tumor resection (TUR) under standard white light or with ALA induced fluorescence were evaluated. MATERIALS AND METHODS: A total of 115 patients with suspected superficial bladder cancer were randomized to undergo standard or ALA assisted TUR. After the second look TUR at 6 weeks patients were followed for a median of 39 (standard) and 42 (ALA) months. RESULTS: Median time to first recurrence was 5 months in the standard and 12 months in the ALA group. Recurrence-free survival was 25% in the standard and 41% in the ALA group. The recurrence rate at 2, 12, 36 and 60 months after initial TUR was 41%, 61%, 73% and 75%, and 16%, 43%, 59% and 59% in the white light and ALA groups, respectively. The total number of recurrences was 82 in the standard and 61 in the ALA group. Tumor progression occurred in 9 patients in the standard and 4 in the ALA group. Cost analysis suggests a considerable economical advantage of ALA fluorescence assisted TUR compared to the standard procedure. CONCLUSIONS: The initial advantage of improved tumor detection and decreased recurrence rates by ALA fluorescence assisted TUR is maintained for years, and effectively reduces morbidity and costs in patients with superficial bladder tumors.     

Clinically relevant improvement of recurrence-free survival with 5-aminolevulinic acid induced fluorescence diagnosis in patients with superficial bladder tumors

PURPOSES: Fluorescence diagnosis induced by 5-aminolevulinic acid enables more thorough transurethral resection of superficial bladder carcinoma compared with conventional white light. We performed a prospective, single institution, randomized trial to investigate whether the residual tumor rate and long-term tumor recurrence can be decreased by fluorescence diagnosis. MATERIALS AND METHODS: A total of 301 patients underwent transurethral resection of bladder tumors with white light or fluorescence diagnosis. Transurethral resection was repeated 5 to 6 weeks later to evaluate the residual tumor rate. To determine recurrence-free survival patient followup was performed every 3 months by white light cystoscopy and urine cytology. Recurrence-free survival was analyzed via Kaplan-Meier methods and multivariable Cox regression analysis. RESULTS: A total of 191 patients with superficial bladder carcinoma were available for efficacy analysis. The residual tumor rate was 25.2% in the white light arm versus 4.5% in the fluorescence diagnosis arm (p <0.0001). Median followup in the white light arm in 103 cases was 21.2 months (range 4 to 40) compared with 20.5 (range 3 to 40) in the 88 in the fluorescence diagnosis arm. Recurrence-free survival in the fluorescence diagnosis group was 89.6% after 12 and 24 months compared with 73.8% and 65.9%, respectively, in the white light group (p = 0.004). This superiority proved to be independent of risk group. The adjusted hazard ratio of fluorescence diagnosis versus white light transurethral resection was 0.33 (95% confidence interval 0.16 to 0.67). CONCLUSIONS: Fluorescence diagnosis is significantly superior to conventional white light transurethral resection with respect to the residual tumor rate and recurrence-free survival. The differences in recurrence-free survival imply that fluorescence diagnosis is a clinically relevant procedure for decreasing the number of tumor recurrences.     

Fluorescence Cystoscopy in Bladder Cancer: The Case Pro

IntroductionNon–muscle-invasive bladder cancer is labour intensive and costly. Due to lifelong monitoring and treatment in many of these patients, it is the most expensive cancer in per-patient terms. A significant part of the costs is due to the high recurrence rate, its treatment, and follow-up.MethodsStudies on fluorescence cystoscopy were reviewed.ResultsFluorescence-guided cystoscopy, using 5-aminolevulinic acid (5-ALA) or its hexyl ester, hexaminolevulinate 5-ALA (HAL), improves the detection of bladder tumours, particularly carcinoma in situ, compared to standard white light cystoscopy. The quality of transurethral resection of the bladder tumour is also improved, as is further patient management. Finally, fluorescence cystoscopy leads to reduced long-term recurrence rates and lower overall costs. The technique is well tolerated and easy.ConclusionFluorescence cystoscopy is safe, better for the patient, and cheaper for community.     

Fluorescence detection of bladder tumors with 5-amino-levulinic acid

BACKGROUND: Preliminary data suggest that photodiagnosis by fluorescence detection of protoporphyrin IX, a biosynthetic product of the photosensitizer 5-amino-levulinic acid (ALA), is superior to conventional cystoscopy in bladder tumor detection. PATIENTS AND METHODS: We instilled 1.5 g of ALA into the bladders of 52 patients with suspect bladder lesions 1 to 4 hours prior to transurethral resection or biopsy. Red fluorescence was induced by violet-blue light (wavelength 380-450 nm). RESULTS: In 13 patients (25%), significant tumors were detected by fluorescence that were missed on conventional cystoscopy. In the present series, ALA photodetection had a sensitivity of 94.6% (compared with 76% for cystoscopy) and a specificity of 43%. CONCLUSION: Fluorescence diagnosis with ALA may become a standard procedure for bladder tumor detection and resection, especially in endoscopically difficult situations (carcinoma in situ, multifocal tumors, multiple prior resections, or previous drug instillation therapy).     

Bladder cancer

Bladder cancer is the second most common malignancy affecting the urinary tract and represents 3% of all cancer deaths in the United Kingdom. The most common presentation is visible haematuria which accounts for 85% of cases. Initial evaluation utilizes white light flexible cystoscopy and upper urinary tract imaging, through ultrasound or CT urography. Alternatives to white light cystoscopy include photodynamic diagnosis and narrow-band imaging which may improve detection of tumours. Initial treatment is with transurethral resection of the bladder tumour (TURBT). En-bloc resection using either laser or electrocautery shows promise in improving the quality of transurethral resection. For patients with muscle-invasive bladder cancer, robot-assisted radical cystectomy has been shown to be oncologically equivalent to open radical cystectomy with recent evidence showing benefit reducing pain and in inpatient stay. Bladder preservation treatment in muscle-invasive cancer is trimodal therapy utilizing transurethral resection and chemoradiotherapy in selected patients. Management of locally advanced and metastatic disease has rapidly advanced through the use of systemic immunotherapy agents targeting the PD-L1/PD-1 axis.     

二次TURBt联合膀胱灌注化疗及肿瘤细胞抗原负载的树突状细胞治疗非肌层浸润性膀胱癌的临床研究

目的 观察二次TURBt联合膀胱灌注化疗及肿瘤细胞抗原负载的树突状细胞(DC)治疗非肌层浸润性膀胱癌的安全性及疗效. 方法 T1期膀胱尿路上皮癌患者80例.男59例,女21例.年龄30～ 85岁,平均65岁.入组患者均在第一次TURBt术后4～6周行二次TURBt,术后常规膀胱灌注化疗.分为2组:DC组40例,对照组40例.DC组自外周血分离出单核细胞,体外诱导分化为DC,加入该患者的肿瘤抗原共培养,获取负载肿瘤细胞抗原的DC;在二次TURBt术后6～8周将肿瘤细胞抗原负载的DC回输,每周1次,共4次,每次腹股沟皮下注射细胞数不低于1×106个,每疗程回输细胞总数＞4×106个.观察DC组免疫指标改变及不良反应,比较2组患者肿瘤复发比例.结果 80例患者第一次TURBt病理分级G117例(21.3％)、G254例(67.5％)、G39例(11.2％);二次TURBt病理检查发现残存肿瘤27例,总阳性率33.7％;Ta期8例(29.6％)、T1期19例(70.4％);G13例(11.1％)、G2 19例(70.4％)、G3 5例(18.5％).二次TURBt时Ta期8例中分级同第一次TURBt 6例,分级升高2例;T1期19例中分级同第一次TURBt 12例,分级升高5例,降级2例.单发16例,均位于原电切处;多发11例,其中原电切处可见菜花样肿瘤7例.DC回输治疗时出现寒战、发热5例,给予地塞米松10 mg静脉推注治疗后缓解.治疗前、治疗后1年及2年患者血中白细胞、SCr、ALT值比较差异无统计学意义(P＞0.05).与治疗前比较,治疗后1年及2年CD4、CD8、CD4/CD8等指标比较差异均有统计学意义(P＜0.05),而治疗后1年后及2年各指标比较差异无统计学意义.DC组1年内复发1例(2％),2年内复发3例(6％);对照组中1年内复发6例(20％);2年内复发9例(30％),2组复发率比较差异有统计学意义(P＜0.05). 结论 二次TURBt联合膀胱灌注及肿瘤细胞抗原负载的DC回输治疗是降低非肌层浸润性膀胱癌复发率较有效的方法.     

5-氨基乙酰丙酸诱导荧光膀胱镜在膀胱肿瘤诊断中的应用（附31例报告）

目的：研究5-氨基乙酰丙酸（5-ALA）诱导荧光光动力学对膀胱肿瘤的早期诊断价值。方法：对血尿患者行5-ALA诱导荧光膀胱镜检查及活组织检查,以5-ALA膀胱灌注,2h后采用D-light光源系统进行膀胱镜检,对荧光阳性区域及白光下肉眼可见异常但荧光阴性区域进行活检,活检后行经尿道膀胱肿瘤电切术。结果：31例患者中有4例荧光阴性且普通光肉眼观阴性者未活检。余27例患者共取活检96处,其中荧光阳性区域取活检89处（包括普通光肉眼观阴性区域35处）,切缘取活检7处。病理检查结果显示：尿路上皮癌65处,阳性率为73．03％（65／89）,非肿瘤性病变24例,假阳性率为27％（24／89）,切缘活检7处为阴性。荧光下阳性而白光下阴性的肿瘤位点11处,切缘活检7处均为阴性。结论：5-ALA诱导荧光光动力学诊断对膀胱肿瘤有较高价值,能发现早期肿瘤,同时进行电切将更彻底。