本文選題：膀胱癌 + 經(jīng)尿道膀胱腫瘤電切術��； 參考：《福建醫(yī)科大學》2014年碩士論文

【摘要】：【目的】經(jīng)尿道二次電切術（repeattransurethral resection,ReTUR）（以下稱為ReTUR）作為治療膀胱癌的一項技術，對其可行性及有效性尚未得到一致認同。本文通過對我院10例經(jīng)二次電切治療的多發(fā)膀胱癌患者進行研究，探討膀胱癌二次電切的適應癥、注意要點及預后等，進一步了解二次電切的臨床意義。 【方法】回顧分析2011年1月至2013年12月我院收治并行ReTUR手術治療的患者共10例，其中9例為非肌層浸潤性膀胱癌，1例為首次行TURBT術后復發(fā)并進展為肌層浸潤性膀胱癌。所有病例均為多發(fā)，均采用經(jīng)尿道膀胱腫瘤電切術（transurethral resection of bladder tumor,TURBT）（以下稱為TURBT）進行治療，均于TURBT術后4-6周后再行ReTUR。首次電切及二次電切術后均于術后7天開始行膀胱內灌注化療，每周一次，共8周；8周后改為每月1次，持續(xù)1-2年。術后每3個月進行膀胱鏡檢查一次，持續(xù)1年改為每半年一次，隨訪記錄患者的腫瘤復發(fā)及進展情況。 【結果】10例患者均已病理證實為膀胱癌，隨訪時間為6-39個月。7例無瘤存活，時間分別為6-39個月，平均時間約為15個月；1例于二次電切術后9個月發(fā)現(xiàn)腫瘤復發(fā)，予再次行TURBT聯(lián)合GC（吉西他濱和順鉑）方案全身化療1周期，6個月后再次發(fā)現(xiàn)腫瘤復發(fā)，再次行TURBT治療后存活；2例分別于二次電切術后8個月及12個月死亡。 【結論】①非肌層浸潤性膀胱癌的主要治療手段仍為經(jīng)尿道膀胱腫瘤電切術聯(lián)合膀胱內灌注化療等治療，但該治療方式復發(fā)率仍較高，而二次電切術能有效降低術后腫瘤復發(fā)率、控制疾病進展、延緩腫瘤復發(fā)。②對于多發(fā)性膀胱癌及部分肌層浸潤性膀胱癌，，如果患者不愿行全膀胱切除術或全身情況不足以支持全膀胱切除術，在嚴格掌握適應癥的條件下，可以采用二次電切術聯(lián)合膀胱灌注化療治療或全身化療的方式，具有一定的治療效果。
[Abstract]:[objective] to evaluate the feasibility and efficacy of transurethral resection of bladder cancer (repeattransurethral resectionor ReTUR) as a technique for the treatment of bladder cancer. Through the study of 10 patients with multiple bladder cancer treated by secondary electroresection in our hospital, the indications, key points and prognosis of secondary resection of bladder cancer were discussed. To further understand the clinical significance of secondary electrotomy. [methods] Ten patients treated with ReTUR from January 2011 to December 2013 were retrospectively analyzed. Among them, 9 cases were non-myometrial invasive bladder cancer and 1 case was recurred after TURBT for the first time and developed into myometrial invasive bladder cancer. All the patients were multiple. All the patients were treated with transurethral resection of bladder tumor (transurethral resection of bladder tumor TURBT) (hereinafter referred to as TURBT). The patients were treated 4-6 weeks after TURBT. Intravesical instillation chemotherapy was performed on the 7th day after the first and second electroresection, once a week, 8 weeks and 8 weeks later, once a month for 1-2 years. Cystoscopy was performed every 3 months after operation, which lasted for one year and was changed to half a year. The recurrence and progression of the tumor were recorded. [results] all the 10 patients were proved to be bladder cancer by pathology. The follow-up time was 6-39 months. The survival time was 6-39 months. The mean time was about 15 months. The recurrence of tumor was found in 1 case 9 months after secondary electroresection. TURBT combined with GC (gemcitabine and cisplatin) regimen was given again for one cycle of systemic chemotherapy. After 6 months the tumor recurred again and survived after TURBT treatment again. Two patients died at 8 months and 12 months after secondary resection. [conclusion] 1 the main treatment of non-myometrial invasive bladder cancer is still transurethral resection of bladder tumor combined with intravesical chemotherapy, etc. However, the recurrence rate of this treatment is still high, and secondary electroresection can effectively reduce the recurrence rate of tumor, control the disease progression, delay the recurrence of tumor, and delay the recurrence of 2. 2 for multiple bladder cancer and partial myometrial invasive bladder cancer. If the patient is unwilling to undergo a total cystectomy or if the whole body condition is insufficient to support a total cystectomy, under strict indications, a second electrotomy combined with intravesical chemotherapy or systemic chemotherapy may be used. It has certain therapeutic effect.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.14

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