根治性经尿道电汽化术切除侵犯肌层膀胱肿瘤的疗效评估

目的评估根治性经尿道膀胱肿瘤电汽化术(根治性TUVBT)治疗膀胱肿瘤的中长期疗效. 方法已侵犯肌层的膀胱肿瘤患者39例.采用根治性TUVBT治疗14例,获随访12例,时间34～66个月,平均44.6个月.参照根治性经尿道膀胱肿瘤电切术的手术原则,汽化切除肿瘤至膀胱壁外脂肪层.采用膀胱部分切除术治疗25例,获随访22例,时间30～96个月,平均50.7个月.两组术后常规10-羟基喜树碱膀胱灌注化疗2年. 结果根治性TUVBT组术后肿瘤复发率33.3%(4/12);膀胱部分切除术组复发率31.8%(7/22),死亡率4.5%(1/22).两组比较,差异无显著性意义(P>0.05). 结论对已侵犯肌层的膀胱肿瘤,根治性TUVBT可作为外科治疗的一种选择,尤其适用于年老体弱或不愿意接受根治性膀胱全切术或开放手术者.

Evaluation of the efficacy of radical transurethral electrovaporization for muscle-invasive bladder tumor

Objective To evaluate the intermediate and long-term efficacy of radical transurethral electrovaporization for bladder tumor (radical TUVBT). Methods Thirty-nine patients with muscle-invasive bladder cancer were entered into the study.Of them 14 patients underwent radical TUVBT.The procedure was based upon the principle of radical transurethral resection for bladder tumor,with the muscle-invasive bladder cancers being electrovaporized to fatty layer outside the bladder wall,as full-thickness resection.12 cases were followed-up for 34 to 66 months with a mean period of 44.6 months.2 cases were lost of follow-up.The remaining 25 patients underwent partial cystectomy.22 cases were followed-up for 30 to 96 months with a mean period of 50.7 months.After operation bladder instillation with 10-hydroxyl camptothecine was given for two years in both groups. Results For radical TUVBT group the recurrence rate was 33.3% (4/12) and for partial cystectomy group the recurrence rate was 31.8% (7/22),with mortality rate being 4.5% (1/22).There was no significant difference between radical TUVBT group and partial cystectomy group ( P >0.05). Conclusions Radical TUVBT can be selected as surgical treatment for muscle-invasive bladder cancer cases,especially for those who are older and weak,and not medically fit for radical cystectomy or those who refuse the open surgery.