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目的:研究5-氨基乙酰丙酸(5-ALA)诱导荧光光动力学对膀胱肿瘤的早期诊断价值。方法:对血尿患者行5-ALA诱导荧光膀胱镜检查及活组织检查,以5-ALA膀胱灌注,2 h后采用D-light光源系统进行膀胱镜检,对荧光阳性区域及白光下肉眼可见异常但荧光阴性区域进行活检,活检后行经尿道膀胱肿瘤电切术。结果:31例患者中有4例荧光阴性且普通光肉眼观阴性者未活检。余27例患者共取活检96处,其中荧光阳性区域取活检89处(包括普通光肉眼观阴性区域35处),切缘取活检7处。病理检查结果显示:尿路上皮癌65处,阳性率为73.03%(65/89),非肿瘤性病变24例,假阳性率为27%(24/89),切缘活检7处为阴性。荧光下阳性而白光下阴性的肿瘤位点11处,切缘活检7处均为阴性。结论:5-ALA诱导荧光光动力学诊断对膀胱肿瘤有较高价值,能发现早期肿瘤,同时进行电切将更彻底。
Objective: To investigate the value of 5-aminolevulinic acid (5-ALA) -induced fluorescence photodynamic therapy in the early diagnosis of bladder cancer. Methods: 5-ALA-induced cystoscopy and biopsy were performed in patients with hematuria. Urinary bladder was infused with 5-ALA. After 2 hours, cystoscopy was performed with D-light system. However, biopsy was performed in the negative fluorescence area and transurethral resection of bladder tumor was performed after biopsy. RESULTS: Four of the 31 patients were fluorescent-negative and had no biopsy of the normal naked eye. A total of 27 cases of patients with biopsy in 96, of which fluorescence-positive area to take biopsy 89 (including the normal light naked eye negative area 35), biopsy 7 biopsy. Pathological examination showed that the positive rate of urothelial carcinoma was 73.03% (65/89) in 65 cases of urothelial carcinoma, 24 cases of non-neoplastic lesions, the false positive rate was 27% (24/89), and 7 of biopsy margins were negative. Fluorescent positive and white negative tumor sites at 11, 7 biopsy margin were negative. Conclusion: 5-ALA-induced fluorescence photodynamic diagnosis of bladder tumors have a higher value, can detect early tumors, while cutting will be more thorough.