首次经尿道膀胱肿瘤切除术的诊断价值及其影响因素探讨

目的探讨首次经尿道膀胱肿瘤切除术（TURBT）的诊断价值及其相关影响因素。方法回顾分析112例初步诊断为非肌层侵润性膀胱癌患者的临床资料，首次TURBT切除肿瘤并确定病理结果，与术后2—6周二次电切术（93例）、部分切除术（9例）和根治切除术（10例）病理结果进行比较。结果首次TURBT切除标本组织形态人为改变23例（20．54％），标本组织肌层缺失35例（31．25％）。比较发现，首次TURBT后肿瘤残余47例（41．96％），病理结果一致84例（75．oo％），病理被低估28例（25．00％）。肿瘤进展风险、肿瘤位置、电切方法和术者经验与首次TURBT肿瘤残余有关（P〈0．05）；Logistic分析得出影响首次TURBT肿瘤残余的因素依次为：肿瘤进展风险〉电切方法〉术者经验〉肿瘤位置；电切方法、术者经验与标本组织肌层缺失有关（P〈0．05）；电切设备与标本组织形态改变有关（P〈0．05）；标本肌层缺失、标本组织形态改变与首次TURBT病理结果正确率有关（P〈0．05）。结论首次TURBT存在肿瘤残余、病理低估等缺陷，主要原因是无法保证高质量的TURBT并留取符合要求的标本，提倡有经验的医师通过双极等离子电刀系统来进行诊断性TURBT，对于高危膀胱肿瘤二次TURBT是有必要的。

Clinical study on the diagnostic value and influencing factors of first transurethral resection of bladder tumor

Objective To investigate the diagnostic value and influencing factors of the first transurethral re- section of bladder tumor （TURBT）. Methods The clinical data was retrospectively analyzed on 112 cases of non- muscle invasive bladder cancer, pathological results of bladder cancer were determined by the first TURBT, and then the pathological results were compared between the first TURBT and the second transurethral resection （93 cases） or partial cystectomy（9 cases） or radical cystectomy （10 cases） after 2 to 6 weeks. Results The tissue morphology changes were found in 23 patients and the absence of the detrusor muscle in 35 patients, relying on the specimens col- lected during the first TURBT. After first TURBT tumor residues were found in 47 patients, and the pathological re- sults were identical in 84 patients and were under-staging in 28 patients by comparison. The risk of tumour progres- sion, the tumor locations, the method of transurethral resection and the operator＇s experience were apparently related to tumor residues after first TURBT（P 〈 0. 05 ）. The degree of relevance was as follows ,from more to less, by logistic re- gression analysis ：the risk of tumour progression, the method of transurethral resection, the operator＇s experience, the tumor locations. The method of transurethral resection and the operator＇ s experience were apparently related to the specimens lacked muscle tissue （ P 〈 0. 05 ）. The transurethral device were apparently related to tissue morphology changes. The specimens lacked muscle tissue and the tissue morphology changes were apparently related to pathologi- cal results from the first TURBT（P 〈 0. 05 ）. Conclusion There are still shortcomings with the first TURBT, such as the high rate of tumor residue and pathological underestimate, the poor quality of specimens. A experienced urologist is advocated to adopt the diagnostic TURBT by bipolar plasmakinetic scalpel system. It is necessary for high-risk tumors to receive a second TURBT.