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目的探讨经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)治疗复发性非肌层浸润性膀胱尿路上皮癌的疗效。方法本组复发性非肌层浸润性膀胱尿路上皮癌63例,肿瘤单发36例,多发27例。肿瘤直径0.2~3.0cm,术前均经膀胱镜检查,活检病理检查确诊为低级别尿路上皮癌。所有患者均行TURBT,术后常规卡介苗或化疗药物膀胱灌注,定期复查膀胱镜。结果 63例均顺利完成手术,无严重手术并发症。术后61例获得随访,随访时间8~62个月,平均36个月,38例长期稳定,未见复发;23例复发,复发率37.7%(23/61)。其中17例再次行TURBT,手术后9例病情稳定,8例术后再次复发,再行TURBT1~4次(其中5例临床分期增至T2,鉴于患者高龄或全身情况较差,仍采用TURBT治疗);6例术后复发,因临床分期增加至T2~T3,行开放手术,其中2例行膀胱部分切除术,4例行根治性膀胱切除术。随访期间死亡2例。结论对于复发性非肌层浸润性膀胱尿路上皮癌,TURBT安全性高,并发症少,疗效确切。对于进展为T2期的老年体弱膀胱癌患者,多次TURBT可改善生活质量,延缓患者生命,可有选择性地应用。
Objective To investigate the efficacy of transurethral resection of bladder tumor (TURBT) in the treatment of recurrent non-muscle invasive bladder urothelial carcinoma. Methods This group of 63 patients with recurrent non-muscle invasive bladder urothelial carcinoma, 36 cases of single tumor, 27 cases of multiple. Tumor diameter 0.2 ~ 3.0cm, preoperative cystoscopy, biopsy confirmed the diagnosis of low-grade urothelial carcinoma. All patients underwent TURBT, postoperative conventional BCG or chemotherapy drug bladder perfusion, regular review cystoscopy. Results 63 cases were successfully completed the operation, no serious complications. Sixty-one patients were followed up for 8 to 62 months with an average of 36 months. Thirty-eight patients were stable with no recurrence. Twenty-three patients relapsed with a recurrence rate of 37.7% (23/61). Among them, TURBT was performed in 17 cases again, 9 cases were stable after operation, 8 cases recurred again after operation, and TURBT was performed again 1 ~ 4 times (5 of them were increased to T2 stage. TURBT was still used in view of the poor age or general condition of the patients. ); 6 cases of postoperative recurrence, due to clinical stage increased to T2 ~ T3, underwent open surgery, of which 2 cases of bladder partial resection, 4 cases of radical cystectomy. Two patients died during follow-up. Conclusion For recurrent non-muscle invasive bladder urothelial carcinoma, TURBT is safe, has fewer complications and has definite curative effect. For patients with advanced bladder cancer who have progressed to T2 stage, multiple TURBT can improve the quality of life, delay the life of the patient and can be selectively applied.