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背景与目的:对于是否需要在膀胱癌全膀胱切除术中常规进行输尿管残端冷冻活检,目前存在争议。本研究探讨输尿管残端冷冻活检在全膀胱切除术中应用的临床意义。方法:回顾性研究我院2002年5月至2006年5月间68例膀胱癌行全膀胱切除术患者的临床病理资料,并将冷冻活检与石蜡切片的结果进行了比较。中位随访时间为2.5年。结果:68例患者中,7例(10.3%)术中冷冻切片证实有一侧输尿管残端异常,其中6例为恶性肿瘤细胞侵润,1例为移行上皮不典型增生。7例患者术中均立即补充切除输尿管残端,并再次送冷冻活检,直到确诊无异常后,再行尿流改道。7例患者的冷冻切片诊断与最终的石蜡切片诊断均相符合。随访中有3例出现肿瘤复发与转移,但均未出现输尿管和肠道吻合口复发。结论:建议在膀胱癌全膀胱切除术中对输尿管残端进行冷冻活检,发现并彻底切除病灶,以改善预后。
BACKGROUND & OBJECTIVE: There is currently controversy regarding the need for routine ureteral stump biopsy during total cystectomy of bladder cancer. This study was to investigate the clinical significance of frozen stump biopsy in total cystectomy. Methods: The clinical and pathological data of 68 cases of bladder cancer undergoing total cystectomy between May 2002 and May 2006 were retrospectively reviewed. The results of frozen biopsy and paraffin section were compared. The median follow-up time was 2.5 years. Results: Of the 68 patients, 7 cases (10.3%) had intraoperative frozen sections confirmed abnormal ureteral stumps, including 6 cases of malignant tumor cells infiltration and 1 case of atypical hyperplasia of transitional epithelium. All 7 patients were surgically removed and resected ureter stump, and sent again frozen biopsy until no abnormalities were confirmed, and then urinary diversion. The frozen section diagnosis in 7 patients was consistent with the final paraffin section diagnosis. There were 3 cases of tumor recurrence and metastasis in follow-up, but no ureter and intestinal anastomotic recurrence. CONCLUSIONS: It is advisable to perform frozen biopsy of the ureter stump during a total cystectomy of bladder cancer to find and completely remove the lesion to improve the prognosis.