【摘要】 目的探讨经尿道膀胱肿瘤电切除术(TURBT)术中留取切缘标本对非肌层浸润性膀胱癌的诊断及治疗价值。方法回顾性分析2012年1月至2014年1月我院泌尿外科收治的80例非肌层浸润性膀胱癌手术患者的临床资料,其中40例留取切缘标本患者为标本组,40例未留取切缘标本患者作为常规组。比较两组患者切缘标本肿瘤阳性率与肿瘤复发率的关系、切缘标本肿瘤分期与肿瘤复发率的关系、无复发生存时间及肿瘤进展情况。结果标本组患者中22.5%(9/40)因切缘标本结果改变最终诊断,20.0%(8/40)更改术后治疗方案;标本组患者中原发灶复发者15例,切缘标本肿瘤患者阳性率为27.5%,阴性率为10.0%,阳性高于阴性,差异具有统计学意义(P<0.05);继发灶复发者15例,其中切缘标本肿瘤患者阳性率为25.0%,阴性率为12.5%,阳性高于阴性,差异具有统计学意义(P<0.05)。标本组患者中,Ta期患者6例,T1 10例,T2 8例,Tis期10例,其中切缘标本肿瘤阳性者均较阴性者多,差异具有统计学意义(P<0.05)。标本组和常规组的无复发生存时间分别为(33.5±2.5)个月、(23.6±2.6)个月,标本组患者的无复发生存时间较常规组长,差异有统计学意义(P<0.05);标本组和常规组的肿瘤进展率分别为7.5%(10/40)、22.5%(19/40),标本组低于常规组,差异均有统计学意义(P<0.05)。结论 TURBT术中留取切缘标本可提高非肌层浸润性膀胱癌的病理诊断准确性、指导术后治疗方案选择、减少肿瘤复发率以及延长无复发生存时间,值得临床借鉴。更多还原

【Abstract】 Objective To evaluate the value of taking surgical margin specimens during transurethral resection of bladder tumor(TURBT) in the diagnosis and treatment of non-muscle-invasive bladder cancer. Methods The clinical data of 80 patients with non-muscle-invasive bladder cancer in Department of Urology Surgery in our hospital from January 2012 to January 2014 were retrospectively analyzed, of which 40 patients had surgical margin specimens collected during TURBT(sample group) and 40 patients had no surgical margin specimens collected(routine group). The relationships between tumor positive rate and tumor recurrence rate of margin specimens, between tumor stage and tumor recurrence rate, and between recurrence free survival time and tumor progression were recorded and compared between the two groups. Results In the sample group, 22.5%(9/40) patients had the final diagnosis changed due to margin specimens, and 20%(8/40) patients had therapeutic regimen changed after operation. There were 15 patients with primary tumor relapse in the sample group, and the tumor positive rate of margin specimens was significantly higher than the negative rate(27.5% vs 10.0%, P<0.05). There were 15 patients with secondary focal recurrence in the sample group, and the tumor positive rate of the margin specimens was significantly higher than the negative rate(25.0% vs 12.5%,P<0.05).There were 6 Ta patients, 10 T1 patients, 8 T2 patients, 10 Tis patients in the sample group, and the tumor positive patients were significantly more than negative patients(P<0.05). The recurrence free survival time of sample group and the routine group were(33.5±2.5) months and(23.6±2.6) months, with statistically significant difference(P<0.05). The tumor progression rate of the sample group and the routine group were 7.5%(10/40) and 22.5%(19/40), with statistically significant difference(P<0.05). Conclusion For patients with non-muscle-invasive bladder cancer, taking surgical margin specimens during TURBT can improve the accuracy of pathological diagnosis, guide the selection of treatment plan,and reduce the recurrence rate and prolong recurrence free survival time, which is worthy of clinical application.更多还原