山东大学学报 (医学版) ›› 2018, Vol. 56 ›› Issue (7): 81-85.doi: 10.6040/j.issn.1671-7554.0.2018.288
• • 上一篇
刘杰1, 崔伟2,车梓2,崔志强2,王策正2,王彤2,李明2,刘玲3,杨全成2,孙彬2,高佃军1,聂清生2
LIU Jie1, CUI Wei2, CHE Zi2, CUI Zhiqiang2, WANG Cezheng2, WANG Tong2, LI Ming2, LIU Ling3, YANG Quancheng2, SUN Bin2, GAO Dianjun1, Nie Qingsheng2
摘要: 目的 探讨经尿道膀胱肿瘤电切术治疗T2期肌层浸润性膀胱癌的临床疗效及安全性。 方法 回顾性分析101例肌层浸润性膀胱癌患者,所有患者术后病理均为浸润性尿路上皮癌(T2期),观察组84例行经尿道膀胱肿瘤电切术,将肿瘤位置膀胱壁全部切除,包括周围1.5 cm膀胱黏膜组织。对照组17例行根治性膀胱切除术,观察记录两组患者复发情况、并发症、生存率及生活质量等临床资料。 结果 观察组平均手术时间(53.1±10.3)min低于对照组的(202.4±31.5)min,观察组平均住院时间(11.7±1.7)d低于对照组的(28.0±4.7)d,观察组平均术中出血量(13.7±6.3)mL少于对照组的(470.6±143.1)mL,差异均有统计学意义(P<0.001)。观察组和对照组1、3、5年生存率分别为97.6%、84.5%、78.5%和94.1%、82.4%、76.4%,组间比较差异均无统计学意义(P>0.05)。观察组4例患者术后出现尿路感染,经抗炎对症治疗后痊愈。对照组1例患者出现肾积水行肾穿刺造瘘引流,1例患者出现输尿管梗阻,2例出现尿路感染行抗炎治疗,1例患者出现急性肠梗阻行手术治疗。观察组较对照组并发症发生率及住院费用低,保留膀胱,生活质量明显提高,患者满意度高。 结论 经尿道膀胱肿瘤电切术对于肿瘤单发、体积较小(直径≤2 cm)、分期较早(T2期)的肌层浸润性膀胱癌疗效可靠,安全性及术后生活质量高。对于肿瘤多发、体积较大(直径>2 cm)的肌层浸润性膀胱癌应首选根治性膀胱切除术。
中图分类号:
[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017[J]. CA Cancer J Clin, 2017, 67(1): 7-30. [2] Satyanarayana R, Kallingal G, Parekh D. Current status of robotic and laparoscopic techniques in radical cystectomy and diversion procedures for bladder cancer review[J] Minerva Urol Nefrol, 2014, 66(1): 1-14. [3] Khosravi-Shahi P, Cabezón-Gutiérrez L. Selective organ reservation in muscle-invasive bladder cancer: review of the literature[J]. Surg Oncol, 2012, 21(1): e17-22. [4] 李军, 李伟, 刘敏, 等. 经尿道前列腺等离子电切术中失血量的相关因素分析[J]. 同济大学学报(医学版), 2014, 35(4): 50-53. LI Jun, LI Wei, LIU Min, et al. Factors affecting hemorrhage during transurethral plasma kinetic resection of prostate[J]. Journal of Tongji University(Medical Science), 2014, 35(4): 50-53. [5] 那彦群. 中国泌尿外科疾病诊断治疗指南[M]. 北京: 人民卫生出版社, 2014: 20-60. [6] Milowsky MI, Rumble RB, Booth CM, et al. Guideline on muscle-invasive and metastatic bladder cancer(European Association of Urology Guideline): American society of clinical oncology clinical practice guideline endorsement[J]. J Clin Oncol, 2016, 34(16): 1945-1952. [7] de Nunzio C, Cindolo L, Leonardo C, et al. Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort[J]. Eur J Surg Oncol, 2013, 39(7): 792-798. [8] Gakis G, Efstathiou J, Lerner SP, et al. ICUD-EAU International consultation on bladder cancer 2012: radical cystectomy and b1adder preservation for muscle-invasive urothelial carcinoma of the bladder[J]. Eur Urol, 2013, 63(1): 45-57. [9] Hautmann RE, de Petriconi RC, Pfiffer C, et al. Radical cystectomy for urothelial carcinoma of the bladder without neoadjuvant or adjuvant therapy: long-term results in 1100 patients.[J]. Eur Urol, 2012, 61(5): 1039-1047. [10] Yoo S, You D, Jeong IG, et al. Does radical cystectomy improve overall survival in octogenarians with muscle-invasive bladder cancer?[J]. Korean J Urol, 2011, 52(7): 446-451. [11] Takeshita H, Kihara K, Masuda H, et al. Bladder sparing therapy in muscle-invasive bladder cancer by induction chemoradiotherapy plus partial cystectomy with pelvic lymph node dissection: assessments of quality of life and urinary functions[J]. J Urol, 2014, 191(4): e555- e555. [12] 高宏, 刘岩, 王泽新, 等. 经尿道电切联合围术期膀胱热灌注治疗老年膀胱癌的疗效[J]. 中国老年学杂志, 2012, 32(8): 1603-1604. [13] 周晓峰, 丁振山, 方丹波, 等. 经尿道保留膀胱的不同手术方法对老年肌层浸润性膀胱癌的疗效分析[J]. 中华医学杂志, 2016, 96(16): 1278-1280. ZHOU Xiaofeng, DING Zhenshan, FANG Danbo, et al. Selective bladder preservation in muscle-invasive bladder cancer by transurethral resection combined with intravesical instillation therapy: analysis of clinical effect in the elderly[J]. Med J China, 2016, 96(16): 1278-1280. [14] Herr HW. Transurethral resection of muscle-invasive bladder cancer: 10-year outcome[J]. J Clin Oncol, 2001, 19(1): 89-93. [15] Solsona E, Iborra I, Collado A, et al. Feasibility of radical transurethral resection as monotherapy for selected patients with muscle invasive bladder cancer[J]. J Urol, 2010, 184(2): 475-480. [16] Culp SH, Dickstein RJ, Grossman HB, et al. Refining patient selection for neoadjuvant chemotherapy before radical cystectomy[J]. J Urol, 2014, 191(1): 40-47. [17] Smith ZL, Christodouleas JP, Keefe SM, et al. Bladder preservation in the treatment of muscle-invasive bladder cancer(MIBC): a review of the literature and a practical approach to therapy[J]. BJU Int, 2013, 112(1): 13-25. [18] Hara T, Nishijima J, Miyachika Y, et al. Primary cT2 bladder cancer: a good candidate for radiotherapy combined with cisplatin for bladder preservation[J]. JPN J Clin Oncol, 2011, 41(7): 902-907. [19] Miyamoto DT, Drumm MR, Clayman RH, et al. Outcomes and tolerability of selective bladder preservation by combined modality therapy for invasive bladder cancer in elderly patients[J]. Int J Radiat Oncol, Biol, Phys, 2017, 99(2):S120. doi: 10.1016/j.ijrobp.2017.06.282. [20] Weiss C, Engehausen DG, Krause FS, et al. Radiochemotherapy with cisplatin and 5-fluorouracil after transurethral surgery in patients with bladder cancer[J]. Int J Radiat Oncol, Biol Phys, 2007, 68(4): 1072-1080. [21] 赵阳, 陈贵平, 王华, 等. 膀胱部分切除术在局限性肌层浸润性膀胱癌治疗中的作用[J]. 中华泌尿外科杂志, 2013, 34(7): 497-500. ZHAO Yang, CHEN Guiping, WANG Hua, et al. Partial cystectomy in treatment of localized muscle invasive bladder cancer[J]. Chin J Urol, 2013, 34(7): 497-500. [22] 褚雷, 李青, 李博, 等. 影响T2期膀胱移行细胞癌患者预后因素分析[J]. 山东大学学报(医学版), 2008, 46(3): 284-287. CHU Lei, LI Qing, LI Bo, et al. Parameters influencing the long-term survival of patients with T2 stage transitional cell carcinoma of the bladder[J]. Journal of Shandong University(Health Sciences), 2008, 46(3): 284-287. [23] Krause FS, Walter B, Ott OJ, et al. 15-year survival rates after transurethral resection and radiochemotherapy or radiation in bladder cancer treatment[J]. Anticancer Res, 2011, 31(3): 985-990. [24] 李炫昊, 杜林栋. 保留膀胱的综合治疗在浸润性膀胱癌中的应用现状[J/CD]. 中华临床医师杂志, 2013, 7(3): 920-923. [25] Griebling TL. Re: Comparison of radical cystectomy with conservative treatment in geriatric(≥80)patients with muscle-invasive bladder cancer[J]. J Urol, 2014, 192(2): 372. doi: 10.1016/j.juro.2014.05.058. [26] Zapatero A, Martin De Vidales C, Arellano R, et al. Long term results of two prospective bladder-sparing trimodality approaches for invasive bladder cancer: neoadjuvant chemotherapy and concurrent radio-chemotherapy[J]. Urology, 2012, 80(5): 1056-1062. |
[1] | 张洁,王爱红,董波,赵鹏. 原癌基因c-jun对毒胡萝卜素内酯处理的小鼠胚胎成纤维细胞生存率的影响[J]. 山东大学学报(医学版), 2016, 54(2): 44-48. |
[2] | 鲍海娥, 杨蓉, 刘风芹, 杨伯家, 白旭, 曹一翠, 邹志强, 胡伟芳, 鲍春妹, 李芙蓉, 张红梅. 自体输血对肿瘤患者术后生存率的影响[J]. 山东大学学报(医学版), 2014, 52(S1): 24-25. |
|