荧光膀胱镜在尿路上皮膀胱癌中的诊断价值

目的:评估以5-氨基乙酰丙酸(5-aminolevulinic acid, 5-ALA)作为荧光剂的荧光膀胱镜检查对非肌层浸润性膀胱癌的诊断价值。方法:按照筛除纳入标准，纳入97名研究对象，膀胱灌注50 mL浓度为3%的5-ALA溶液，保留1小时后，排空膀胱后置入膀胱镜，分别在普通白光和荧光下观察，对白光和/或荧光下显示阳性或可疑区域取组织做病理活检，同时行电切术。结果:97例患者中，19例患者普通白光膀胱镜及荧光膀胱镜下检查均为阴性，剩余78例患者取156处组织进行活检，平均每例患者取2块组织。结果显示97处病理报告为尿路上皮癌。经计算得出荧光膀胱镜的敏感性为91.75%(89/97),特异性为64.41%(38/59);普通白光膀胱镜的敏感性为71.13%(69/97),特异性55.93%(33/59);P<0.05,差异具有统计学意义。结论:荧光膀胱镜在诊断尿路上皮膀胱癌上的敏感性和特异性均显著高于普通白光膀胱镜，具有较高的临床应用价值。

Value of fluorescence cystoscopy in diagnosis of urothelial bladder cancer

Objective:To investigate the value of 5-aminolevulinic acid (5-ALA) photosensitizer fluorescence cystoscopy for the diagnosis of non-muscle-invasive bladder cancer (NMIBC).Methods:The 97 participants met the criteria for inclusion in this study.After a 1 h period of perfusion with 50 mL 5-ALA solution in bladder,the bladder was emptied and cystoscope was placed.Fluorescence cystoscopy and white light cystoscopy were performed for 97 patients．Lesions found either under white light or fluorescence light were biopsied and then resected.Results:Among the 97 patients,19 patients were negative under common white light cystoscopy and fluorescent cystoscopy,and 156 tissues were biopsied from the remaining 78 patients,with an average of 2 tissues taken from each patient.Histopathologic examination showed that 97 sites of them were urothelial carcinoma.Statistic analysis indicated a sensitivity of 91.75%(89/97) and a specificity of 64.41%(38/59) for fluorescence cystoscopy，and a sensitivity of 71.13%(69/97) and a specificity of 55.93%(33/59) for white light cystoscopy.Conclusion:Fluorescence cystoscopy has proved to be a valuable detection method with high sensitivity and spectivity for the nonmuscle invasive bladder carcinoma．