经尿道膀胱肿瘤电切术与膀胱部分切除术在肌层浸润性膀胱癌患者中的治疗效果差异

摘要

Objective To study the effect difference of transurethral resection of bladder tumor and partial cystectomy in the treatment of patients with muscle-invasive bladder cancer.Methods 52 patients with muscle-invasive bladder cancer who wanted the bladder to be preserved in our hospital were selected as the research objects;according to the operation methods,all patients were divided into two groups,26 patients in each group.One group underwent transurethral resection of bladder tumor (TURBT),while another group underwent partial cystectomy.After the operation,all patients received chemotherapy by bladder perfusion.After 3-year follow-up,the surgery situation,postoperative complications,prognosis,and the life quality of the two groups were compared.Results The differences of the operation time,intraoperative blood loss,catheter removal time,and hospital stay of the two groups were not statistically significant (P＞0.05).The differences of postoperative complication rate of the two groups such as bladder spasm,bleeding,and urinary fistula were not statistically significant (P＞0.05).The disease-free survival rate of TURBT group at 1 and 3 years after operation were 92.3％,46.2％,which were higher than 53.9％,19.2％ of PC group,with statistically significant differences (P＜0.05).The difference of the overall survival rate of the two groups at 6 months,1 year,and 3 years after operation was not statistically significant (P＞0.05).The physiologically,psychologically related life quality scores of TURBT group at 6 months,1 year after operation were higher than those of PC group,with statistically significant differences (P＜0.05).Conclusions TURBT has the similar effect in the treatment of muscle-invasive bladder cancer to PC,but TURBT can effectively extend the disease-free survival period,and improve the patients' quality of life,so when the patients can't tolerate radical cystectomy or want to preserve the bladder,TURBT has the priority.%目的 探讨经尿道膀胱肿瘤电切术与膀胱部分切除术在肌层浸润性膀胱癌患者中的治疗效果差异.方法 选择本院收治的52例要求保留膀胱的肌层浸润性膀胱癌患者作为本次研究对象,根据手术方法分为经尿道膀胱肿瘤电切术(TURBT)组和膀胱部分切除术(PC)组,每组26例患者,两组患者术后均行常规膀胱灌注化疗,随访3年,比较两组患者的手术情况、术后并发症、预后情况及生活质量评分.结果 两组患者的手术时间、术中出血量、术后拔出尿管时间及住院时间比较差异均无统计学意义(P＞0.05);两组患者术后出现膀胱痉挛、出血及尿瘘等并发症情况之间的差异无统计学意义(P＞0.05);TURBT组患者术后1年、术后3年的无瘤生存率为92.3％、46.2％,高于PC组患者的53.9％、19.2％,差异有统计学意义(P＜ 0.05);两组患者术后6个月、术后1年及术后3年的总生存率差异无统计学意义(P＞ 0.05);TURBT组患者术后6个月、术后1年的生理、心理相关生活质量评分均高于PC组患者,差异有统计学意义(P＜0.05).结论 TURBT与PC对肌层浸润性膀胱癌患者的治疗效果相似,但TURBT治疗能更有效地延长患者的无瘤生存期,更好地改善患者的生活质量,在患者身体不能耐受根治性全膀胱切除术或要求保留膀胱时,可优先考虑TURBT.