【作者】 陈伟；

【导师】 梁朝朝；

【作者基本信息】 安徽医科大学 ， 外科学（泌尿外）， 2018， 硕士

【摘要】 目的对比非肌层浸润性膀胱肿瘤(NMIBC)患者行经尿道膀胱肿瘤电切术(TURBT)与经尿道膀胱肿瘤二次电切术(Re-TURBT)的术后复发率及进展率,研究NMIBC复发及进展的相关危险因素及二次电切不同手术时机对患者预后的影响。方法采用前瞻性临床随机对照研究,分析2015年7月至2017年7月在安徽医科大学第一附属医院进行手术治疗的NMIBC患者95例。按照术前制定的筛选标准,将患者分为TURBT组55例及Re-TURBT组40例。随访截止时间2017年11月1日。采用Kaplan-Meier法绘制生存曲线、计算平均生存时间及生存率。单因素分析采用Log-rank检验,多因素分析采用Cox比例风险模型。结果(1)Re-TURBT组在术后复发率及进展率方面均优于TURBT组,TURBT组及Re-TURBT组术后平均无复发生存时间分别为16.94个月VS 21.86个月(P<0.05),术后12个月无复发生存率(RFS)分别为:65.8%VS 86.9%,平均无进展生存时间分别为20.56个月VS 23.73个月(P<0.05),术后18个月无进展生存率(PFS)分别位73.7%VS 86.3%(P<0.05);(2)单因素分析结果提示:组别、肿瘤大小、临床分期及病理分级是肿瘤复发及进展的影响因素;多因素分析结果显示:组别、肿瘤大小、病理分级为肿瘤复发的独立影响因素;组别、肿瘤大小、临床分期为肿瘤进展的独立影响因素;(3)Re-TURBT组患者根据两次手术间隔时间长短分为两组:≤6周和>6周,两组患者之间的平均无复发生存时间分别为24.00个月VS 16.93个月(P<0.05),差异具有统计学意义。两组患者间无进展生存时间分别为24.00个月VS21.00个月(P>0.05),差异无统计学意义。结论二次电切可以显著降低术后膀胱癌复发及进展的风险。对于体积较大(≥30mm),分期较高(≥T1期),病理级别为高级别的肿瘤应行Re-TURBT以降低肿瘤复发率及进展率。行二次电切手术的患者,第二次手术应在第一次手术后的6周内进行。更多还原

【Abstract】 Objective The aim of this study is to compare the recurrence and progression rate of non-muscle invasive bladder cancer(NMIBC)undergoing transurethral resection of bladder tumor(TURBT)and repeated transurethral resection of bladder tumor(Re-TURBT),to investigate the risk factors associated with the recurrence and progression of NMIBC,and the impact of different timing of Re-TURBT on the prognosis of patients.Methods A total of 95 consecutive NMIBC patients with surgery during July 2015 and July 2017 in the First Affiliated Hospital of Anhui Medical University were enrolled and divided into TURBT group(n=55)and Re-TURBT group(n=40)according to preoperative screening criteria.The follow-up deadline was November 1,2017.The survival curve was drawn by Kaplan-Meier method,and the average survival time and survival rate were calculated.Logistic rank test was used in univariate analysis.Cox regression model was used in Multivariate analysis.Results(1)The recurrence rate and progression rate of Re-TURBT were lower than those of TURBT group.The average recurrence-free survival time of TURBT group and Re-TURBT group were 16.94 months vs.21.86 months(P <0.05),and recurrence-free survival rate(RFS)at 12 months was 65.8% VS 86.9%(P <0.05).The progression-free survival rate(PFS)at 18 months was 73.7% VS 86.3%(P <0.05).The mean progression-free survival time was 20.56 months vs 23.23 months(P <0.05).(2)The results of univariate analysis indicated that the group,tumor size,clinical stage and pathological grade were influence factors of tumor recurrence and progression.Multivariate analysis showed that the group,tumor size and pathological grade were the independent risk factors of tumor recurrence;group,tumor size,clinical stage of tumor were the independent risk factors of tumor progression.(3)The patients in Re-TURBT group were divided into two groups according to the length of the interval between TURBT and Re-TURBT: ≤6 weeks and >6 weeks.The mean recurrence-free survival time was 24.00 months vs 16.93 months(P <0.05),with significant difference between two groups.The progression-free survival time between the two groups were 24.00 months vs 21.00 months with no statistical significance(P> 0.05).Conclusion Re-TURBT can reduce the risk of recurrence and progression of bladder cancer.Re-TURBT should be used to reduce the tumor recurrence rate and progression rate in patients with large tumor size(≥30mm),high clinical stage(≥T1 stage)and high pathological grade.In patients undergoing Re-TURBT,the second surgery should be performed within 6 weeks after the first surgery.更多还原