非肌层浸润性膀胱癌患者术前是否需要常规行IVU检查

摘要

Objective To discuss the need for performing intravenous urography(IVU) in patients with non-muscle invasive bladder cancer before surgery. Methods From 1997 to 2008,1968patients were diagnosed as non-muscle invasive carcinoma of the bladder with pathological confirmation. All patients underwent ultrasonography, cystoscopy and IVU prior to surgrey. The x2 test was used for statistical analysis. Results The incidence of upper urinary tract urothelial tumors (UUTUT) was 11. 0% (216 cases). Two hundred and fifteen (13. 6%) suffered simultaneous UUTUT detected by IVU in 1528 patients with bladder cancer who had intermittent painless gross hematuria, while only 1 (0.3 %) suffered simultaneous UUTUT in 386 non-symptomatic patients (P＜0.01). Among 120 patients with bladder cancer whose upper tract was abnormal detected by ultrasonography,120 (100. 0%) suffered simultaneous UUTUT detected by IVU, and of 1848 patients who were normal in upper tract by ultrasonography, 96 (5. 2%) suffered simultaneous UUTUT detected by IVU (P＜0. 01). Of the patients with no abnormalities in upper tract by ultrasound, 37(3. 0%) suffered simultaneous UUTUT detcted by 1VU in 1247 patients with single bladder tumor,and 59 (9.8%) suffered simultaneous UUTUT in 601 patients with multiple bladder tumors (P＜0.01). Of the patients with single bladder tumor who had no abnormalities in upper tract by ultrasonography, 2 (0.2%) suffered simultaneous UUTUT detected by IVU in 822 patients with the diameter of the tumor＜1.0 cm, and 35 (8. 2 %) suffered simultaneous UUTUT in 425 patients with the diameter≥1. 0 cm (P＜0.01). Of the 1541 patients with histological G1, 48 (3.1%) suffered simultaneous UUTUT detected by IVU, and of the 427 patients with histological G2- G3, 168 (39. 3%)suffered simultaneous UUTUT (P ＜ 0. 01 ). Conclusion Patients with the following characters should undergo IVU before surgery: hematuria, abnormal upper urinary tract by ultrasonography,multifocal tumours, the diameter of the single bladder tumor≥1. 0 cm and high gradc tumors.%目的 探讨非肌层浸润性膀胱癌患者术前是否需要常规行IVU检查.方法 病理确诊为非肌层浸润性膀胱癌患者1968例.男1021例,女947例.年龄16～84岁,平均57岁.病理分期均为Ta～T1,细胞分级G11541例、G2382例、G345例.术前均行双肾输尿管膀胱超声、膀胱镜、IVU检查.均行经尿道膀胱肿瘤切除术.统计学比较分析不同检查方法上尿路癌的检出率.结果 1968例患者中同时发生上尿路癌216例(11.0%).1582例血尿者IVU检查发现上尿路癌215例(13.6%),386例偶然发现膀胱癌患者IVU检查发现上尿路癌1例(0.3%),有无血尿者IVU检查发现上尿路癌比例差异有统计学意义(P＜0.01).超声检查示上尿路异常者120例IVU检查均发现上尿路癌(100.0%),1848例超声检查上尿路无异常者IVU检查发现96例(5.2%),组间比较差异有统计学意义(P＜0.01);1247例超声检查上尿路无异常的单发肿瘤患者IVU检查发现上尿路癌37例(3.0%),601例多发者IVU检查发现59例(9.8%),组间比较差异有统计学意义(P＜0.01);超声检查上尿路无异常的单发膀胱肿瘤直径＜1.0 cm者IVU检查发现上尿路癌2例(0.2%),肿瘤直径≥1.0 cm者IVU检查发现35例(8.2%),组间比较差异有统计学意义(P＜0.01).G1患者同时发生上尿路癌48例(3.1%),G2～G3168例(39.3%),组间比较差异有统计学意义(P＜0.01).结论 非肌层浸润性膀胱癌患者中有血尿症状、超声检查上尿路异常者、超声检查上尿路未见异常的膀胱肿瘤多发或单发但直径≥1.0 cm者、膀胱镜检查肿瘤可疑高级别者应行IVU检查;偶发病例、单发肿瘤且直径＜1.0 cm、肿瘤低级别者,术前可不行IVU检查.