经尿道电切术治疗非肌层浸润性膀胱癌的疗效与手术技巧

摘要

目的:评估经尿道肿瘤电切术(transurethral resection of bladder tumor,TURBT)治疗早期非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)的治疗效果.方法:选取早期NMIBC患者49例,均予以TURBT手术,术后辅以丝裂霉素灌注化疗,定期复查.详细记录手术相关情况,观察肿瘤复发情况.结果:本组49例均顺利完成手术,肿瘤切除率为100.0％,手术时间、术中出血量、术后留置尿管时间分别为(29.1±5.4)min、(32.1±7.6)mL、(2.3 ±0.9)d;术中发生闭孔神经反射6例,膀胱穿孔5例,尿道狭窄2例.随访24个月,未见死亡相关病例,其中术后6个月、12个月、18个月及24个月内分别复发2例、3例、2例、4例,复发率为23.4％(11/47),中位复发时间为17.4个月.结论:TURBT治疗早期NMIBC具有创伤小、并发症少、可多次进行等优点,联合术后灌注化疗可在一定程度上预防复发.%Objective:To evaluate the therapeutic efficacy of transurethral resection of bladder tumor (TURBT) in the treatment of non-muscle invasive bladder cancer (NMIBC).Methods:Totally 49 patients with early NMIBC were selected.They were treated with TURBT surgery and given infusion chemotherapy of mitomycin after surgery.Reexamination was conducted at regular intervals.Surgery-related conditions were recorded,and recurrence rate of tumors was observed.Results.:The surgeries of all patients in this study were completed successfully,and the tumor resection rate was 100.0％.The operative time,amount of intraoperative bleeding and time of postoperative indwelling catheter were (29.1 ± 5.4) min,(32.1 ± 7.6) mL and (2.3 ± 0.9) d,respectively.During surgery,there were 6 cases of obturator nerve reflex,5 cases of vesical perforation and 2 cases of urethrostenosis.No deaths were occurred during 24-month follow-up visit.There were 2,3,2 and 4 cases respectively suffering from recurrence in postoperative 6,12,18 and 24 months,and the recurrence rate was 23.4％ (11/47).The median recurrence time was 17.4 months.Conclusion:TURBT has advantages of small trauma,less complications and availability of repeated operations in the treatment of early NMIBC,and its combination with postoperative perfusion chemotherapy can prevent the tumor recurrence to some extent.