天津医药

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经尿道电切术治疗肌层浸润性膀胱癌的疗效分析

王承承1,孙晓玲2,吴长利3   

  1. 1. 天津市滨海新区大港油田海滨人民医院泌尿外科
    2. 天津海滨人民医院泌尿外科
    3. 天津医科大学第二医院泌尿外科；天津市泌尿外科研究所
  • 收稿日期:2014-01-28 修回日期:2014-07-21 出版日期:2014-11-15 发布日期:2014-11-15
  • 通讯作者: 王承承

The Clinical Analysis of Transurenthral Resection Therapy for Muscle Invasive Bladder Cancer

WANG Cheng cheng1,SUN Xiao ling1,WU Chang li2   

  1. 1. Department of Urology,Tianjin Binhai People’s Hospital
    2. Department of Urology, Second Hospital of Tianjin Medical University
  • Received:2014-01-28 Revised:2014-07-21 Published:2014-11-15 Online:2014-11-15
  • Contact: WANG Cheng cheng

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摘要：

【摘要】 目的 分析比较经尿道电切术与根治性膀胱切除术治疗肌层浸润性膀胱癌的疗效， 探讨影响预后的因素。 方法 回顾性分析 74 例肌层浸润性膀胱癌患者的资料， 接受根治性膀胱切除术 38 例（A 组）， 术后给予静脉化疗。 经尿道电切术 36 例（B 组）， 术后给予静脉、膀胱灌注化疗。 所有患者平均随访 61（5~91）个月 ， 对 2 组手术时间、术中失血量、累积住院时间、肿瘤复发率、5 年存活率等进行比较。 对可能影响患者预后的因素采用 Log-rank 单因素和 Cox 多因素分析。 结果 B 组手术时间、术中出血量及累积住院时间少于 A 组（P < 0.01）， 2 组复发率及 5 年生存率差异无统计学意义（均 P＞ 0.05）。 单因素分析显示肿瘤直径≥5 cm 、T3 期是患者 5 年无复发生存率和 5 年总生存率的危险因素。 多因素分析显示， 肿瘤直径≥5 cm（RR=3.687, 95%CI:1.913~7.105, P＜ 0.001）是患者术后复发的危险因素； T3 期（RR=3.325, 95%CI:1.437~7.695, P=0.005）、肿瘤直径≥5 cm（RR=5.017, 95%CI:2.440~10.317, P=0.002）是影响患者 5 年总生存率的危险因素。 结论 经尿道电切术联合辅助静脉、膀胱灌注化疗可用于浸润性膀胱癌的患者。 肿瘤直径≥5 cm、T3期是影响患者预后的重要因素。

关键词: 膀胱肿瘤, 经尿道电切术, 根治性膀胱癌切除术

Abstract:

[Abstract]    Objective   To compare the transurenthral resection to radical cystectomy on muscle invasive bladder
cancer, and to explore the factors affecting the prognosis.   Methods   Data of 74 patients with muscle invasive bladder cancer were retrospectively analyzed. There were 38 cases underwent radical cystectomy (group A), and were treated with intra?venous chemotherapy after operation. There were 36 cases underwent transurenthral resection (group B), and were treated with intravenous and urinary bladder irrigation chemotherapy. All patients were followed up 61 (5-91) months. Data were compared between two groups including duration of surgery, intraoperative blood loss, the cumulative length of hospital stay, cancer recurrence rate and 5-year survival rate . The factors may affecting the prognosis in patients were collected and ana?lyzed by the Log-rank univariate and Cox multivariate analyzed. Results   The values of operation time, intraoperative blood loss and the cumulative length of hospital stay were significantly lower in group B than those of group A (P < 0.01). There were no significant differences in cancer recurrence rate and 5-year survival rate between two groups (P > 0.05). Results of the Log-rank univariate analysis showed that the tumor size ≥5 cm and T3 stage were the important factors of 5-year relapsefree survival rate and 5-year overall survival rate. Results of the Cox multivariate analysis showed that the tumor size≥5 cm(RR=3.687, 95%CI:1.913-7.105, P＜ 0.001) was the important factor of recurrence in patients after operation. T3 stage (RR=3.325, 95%CI:1.437-7.695, P=0.005) and tumor size ≥5 cm (RR=5.017, 95%CI:2.440-10.317, P=0.002) were the risk factors of the 5-year overall survival rate.   Conclusion   The transurenthral resection with intravenous and urinary bladder irrigation chemotherapy deserves recommendation for the treatment of muscle invasive bladder cancer. Tumor size ≥5 cm and
T3 stage are the important factors for the prognosis.

Key words: urinary bladder neoplasms, transurenthral resection, radical cystectomy