高危非肌层浸润膀胱尿路上皮癌术后再活检和电切的临床意义

目的 探讨术后再活检和电切术可否减少高危非肌层浸润膀胱尿路上皮癌的复发和进展.方法 高危非肌层浸润膀胱尿路上皮癌123例,经尿道电切术后4～6周进行再活检或电切52例,同期未行再次电切而常规随访71例,比较2组患者肿瘤复发和进展情况.结果 再活榆或电切的52例中,发现残存肿瘤28例(54%),其中肌层浸润肿瘤5例,行膀胱全切治疗2例、患者拒绝行膀胱全切3例.随访12～43个月,中位时间27个月,肿瘤复发24例(48%),进展为肌层浸润肿瘤10例(20%);常规随访组肿瘤复发49例(69%),肿瘤进展23例(32%).2组患者肿瘤复发率比较差异有统计学意义(P<0.05),肿瘤进展率比较差异无统计学意义(P0.05).结论 首次电切术后再活检和电切可以降低高危非肌层浸润膀胱尿路上皮癌的复发率,但不能减少肿瘤进展的风险.

Clinical effects of second biopsy and resection in patients with high risk superficial transitional cell carcinoma of the bladder

Objective To explore the effects of second biopsy and resection on tumor recurrence and progression in patients with high risk non-muscle invasive bladder cancer. Methods The second biopsy and resections were performed 4-6 weeks after the first transurethral resection in 52 patients. Routine follow-up was done in another 71 patients. The tumor recurrence and progression rates were compared. Results Residual tumors were found in 54%(28/52) of patients underwent second biop-sy and resection, including muscle-invasive tumors in 5 patients. Two patients underwent radical cys-tectomy due to resection findings. During same period, 71 patients were routinely followed. After a median observation of 27 months, patients underwent second biopsy and resection showed lower recur-rence rate (P<0.05). The progression rate was no difference between the 2 groups(P0.05). Conclusion Second biopsy and resection may reduce recurrence rate in high risk non-muscle invasive bladder cancers, but may not change the tumor progression rate.