高危浅表膀胱尿路上皮癌术后短期再活检和电切的临床意义

目的:探讨术后短期再活检和电切是否可以减少高危浅表尿路上皮癌的复发和进展。方法:对部分高危浅表膀胱尿路上皮癌在经尿道电切术后4~6周进行再活检或电切,与同时期进行常规随访的患者的肿瘤复发和进展情况进行比较。结果:52例患者在经尿道电切术后4~6周进行了再活检或电切,28例(53.8%)发现残存肿瘤,其中5例为肌层浸润肿瘤,2例行膀胱全切治疗。同期常规随访71例高危浅表膀胱尿路上皮癌患者。经过最少12个月,平均25个月随访,术后短期再活检组的肿瘤复发率较低(P<0.05),但两组间进展为肌层浸润肿瘤的发生率无统计学差异(P>0.05)。结论:首次电切术后短期再活检和电切可以降低高危浅表膀胱尿路上皮癌的复发率,但不能减少肿瘤进展的风险。

The Clinical Effects of Second Biopsy and Resection in Patients with High Risk Urothelial Carcinoma of the Bladder

Objective： To explore the effects of second biopsy and resection on tumor recurrence and progression in patients with high risk urothelial carcinoma of the bladder. Methods： The second biopsy and resection were performed in some patients 4-6 weeks after the first transurethral resection and the tumor recurrence and progression rates in these patients were compared with that of routinely followed patients. Results： Residual tumors were found in 53. 8% （28/52） of patients undergone second biopsy and resection, including muscle-invasion tumors in 5 patients. 2 patients underwent radical cystectomy due to resection findings. During same period, 71 patients were routinely followed. After a mean. a minimum of 12,observation of 25 months, patients undergone second biopsy and resection showed lower recurrence rate than that of routinely followed patients（P〈0. 05）, although the progression rate was no difference between them（P〉0. 05）. Conclusions： Second biopsy and resection reduce recurrence rate in high risk superficial bladder cancers, but tumor progression seems unchanged.