經(jīng)尿道二次電切術(shù)治療非肌層浸潤性膀胱癌的臨床分析
發(fā)布時(shí)間：2019-06-04 08:58
【摘要】：目的:探討經(jīng)尿道二次電切術(shù)治療非肌層浸潤性膀胱癌的療效及必要性。方法:回顧性統(tǒng)計(jì)分析自2013年1月至2015年12月就診于天津市腫瘤醫(yī)院的123例行經(jīng)尿道膀胱腫瘤切除術(shù)后病理證實(shí)為非肌層浸潤性膀胱癌患者的臨床病例資料特點(diǎn)。根據(jù)是否行re TUR,分為re TUR組54例和常規(guī)隨訪組69例。所有患者術(shù)后均給予即刻及后續(xù)膀胱灌注治療,灌注藥物為表柔比星或吉西他濱。術(shù)后定期進(jìn)行膀胱鏡復(fù)查。通過查閱患者臨床病例及病理資料,了解re TUR組患者術(shù)后腫瘤殘余及重新分期情況,所有患者通過電話、門診病例及復(fù)查記錄進(jìn)行隨訪,了解患者術(shù)后恢復(fù)以及有無復(fù)發(fā)情況,并將兩組患者的復(fù)發(fā)情況進(jìn)行比較。并對影響腫瘤復(fù)發(fā)的各因素進(jìn)行單因素和多因素統(tǒng)計(jì)分析。所有患者的臨床病例及病理資料完整,患者隨訪時(shí)間為6~48個(gè)月,中位隨訪時(shí)間為26個(gè)月。將患者的資料及隨訪結(jié)果進(jìn)行整理,建立數(shù)據(jù)庫,應(yīng)用統(tǒng)計(jì)學(xué)軟件SPSS17.0進(jìn)行分析,單因素分析采用Kaplan-Meier法,不同組間比較采用Log rank檢驗(yàn),多因素分析采用Cox比例風(fēng)險(xiǎn)模型。復(fù)發(fā)時(shí)間為患者手術(shù)時(shí)間至組織病理學(xué)證實(shí)腫瘤復(fù)發(fā)的時(shí)間。以P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.兩組患者的基本病例資料特點(diǎn):本研究共123例患者,其中69例接受單次電切,54例接受re TUR。re TUR組患者中,男性46例,女性8例,年齡20~76歲,平均58歲。單發(fā)腫瘤24例,多發(fā)腫瘤30例,臨床分期:Ta期28例,T1期26例。腫瘤分級:低級別4例,中級別21例,高級別29例。危險(xiǎn)度分層:中�；颊�49例,高�；颊�5例,腫瘤直徑:≤3cm者37例,3cm者17例。常規(guī)隨訪組患者中,男性58例,女性11例,年齡27~82歲,平均59歲。單發(fā)腫瘤35例,多發(fā)腫瘤34例,臨床分期:Ta期42例,T1期27例。腫瘤分級:低級別19例,中級別25例,高級別25例。危險(xiǎn)度分級:中�；颊�64例,高危患者5例,腫瘤直徑:≤3cm者42例,3cm者57例。兩組患者的性別、年齡、分期、分級、腫瘤數(shù)目、腫瘤直徑等一般資料均無統(tǒng)計(jì)學(xué)差異(P0.05)。2.re TUR組患者腫瘤殘余情況:54例接受re TUR的患者中,4例出現(xiàn)腫瘤殘余,腫瘤殘余率為7.4%。其中2例為T1G3,1例為T1G2,1例為Ta G2。殘余腫瘤中,2例病理提示僅基底少量殘留,1例由G2級降至G1級,1例病理分期分級不變。3.兩組患者復(fù)發(fā)情況比較:截止隨訪時(shí)間,共17例患者出現(xiàn)復(fù)發(fā),復(fù)發(fā)率為13.8%。re TUR組復(fù)發(fā)6例(11.1%),其中原位復(fù)發(fā)2例;常規(guī)隨訪組復(fù)發(fā)11例(15.9%),原位復(fù)發(fā)2例。通過比較發(fā)現(xiàn)兩組患者復(fù)發(fā)率差異沒有統(tǒng)計(jì)學(xué)意義(P0.05)。4.與復(fù)發(fā)相關(guān)的單因素分析結(jié)果:術(shù)后病理分期、分級、腫瘤數(shù)目、既往復(fù)發(fā)率和危險(xiǎn)分層是影響患者復(fù)發(fā)的危險(xiǎn)因素(P0.05),而是否行re TUR、性別、年齡、膀胱灌注藥物的不同、腫瘤大小等與患者復(fù)發(fā)無相關(guān)性(P0.05)。5.與復(fù)發(fā)相關(guān)的多因素分析結(jié)果:將單因素分析中有統(tǒng)計(jì)學(xué)意義的危險(xiǎn)因素和是否行re TUR導(dǎo)入Cox比例風(fēng)險(xiǎn)模型,結(jié)果顯示,只有腫瘤數(shù)目是影響非肌層浸潤性膀胱癌患者復(fù)發(fā)的獨(dú)立危險(xiǎn)因素(P0.05)。排除影響腫瘤復(fù)發(fā)的其他因素,是否行re TUR對患者術(shù)后復(fù)發(fā)無影響。結(jié)論:NMIBC患者TURBT術(shù)后具有較高復(fù)發(fā)率,導(dǎo)致高復(fù)發(fā)率的主要原因是腫瘤殘余。因此,完全、徹底地切除腫瘤組織是預(yù)防NMIBC復(fù)發(fā)的有效方式。腫瘤數(shù)目是影響患者復(fù)發(fā)的獨(dú)立危險(xiǎn)因素,而re TUR對降低非肌層浸潤性膀胱癌患者的復(fù)發(fā)率沒有顯著意義,因此行re TUR的必要性還有待進(jìn)一步探討。在臨床上,進(jìn)行規(guī)范的TURBT手術(shù)操作,提高手術(shù)醫(yī)師的操作水平,增加與病理醫(yī)師的溝通,術(shù)后即刻膀胱灌注化療及維持灌注,聯(lián)合新技術(shù)等可以提高首次TURBT質(zhì)量,減少腫瘤殘余,降低術(shù)后復(fù)發(fā)率,從而避免不必要的re TUR。
[Abstract]:Objective: To study the effect and necessity of transurethral resection of the bladder for non-myometrial invasion. Methods: The clinical data of 123 patients with non-myometrial invasion of bladder cancer from January 2013 to December 2015 were retrospectively analyzed. According to whether they were re-TUR, there were 54 cases of re-TUR group and 69 cases of routine follow-up group. All patients were given immediate and follow-up bladder perfusion after operation, and the infusion drug was epirubicin or gemcitabine. The cystoscope reexamination was performed on a regular basis. By referring to the patient's clinical and pathological data, we know the residual and re-staging of the postoperative tumor in the re TUR group. All the patients were followed up by telephone, out-patient and re-examination records to understand the postoperative recovery and the recurrence of the patients. And the recurrence of the two groups of patients was compared. The factors influencing the recurrence of the tumor were analyzed by single factor and multi-factor analysis. The clinical and pathological data of all patients was complete, and the follow-up time of the patient was 6-48 months, and the median follow-up time was 26 months. The data and follow-up results of the patients were sorted, the database was established, and the statistical software SPSS17.0 was used for analysis. The single factor analysis was performed using the Kaplan-Meier method, and the Log rank test was used for the comparison among the different groups. The Cox proportional hazard model was used for the multi-factor analysis. The time of recurrence is the time of the patient's operation time to the tissue pathology to confirm the recurrence of the tumor. The difference of P0.05 was of statistical significance. Results:1. The basic case data of the two groups were as follows: in this study, there were 123 patients in this study, of which 69 received a single electrical cut and 54 received re-TUR.re TUR,46 male and 8 female, aged 20 to 76, with an average age of 58. There were 24 cases of single tumor,30 cases of multiple tumors,28 cases of Ta stage and 26 cases in T1 stage. Tumor classification: low grade 4 cases, medium grade 21 cases, high-level 29 cases. Risk stratification:49 cases of middle-risk patients,5 cases of high-risk patients,37 cases of tumor diameter, and 17 cases of 3cm. In the routine follow-up group,58 male and 11 female, aged 27 to 82, were 59 years of age. There were 35 cases of single tumor,34 cases of multiple tumors,42 cases of Ta and 27 in T1. Tumor classification: low grade 19 cases, medium grade 25 cases, high-level 25 cases. Risk classification:64 patients with intermediate risk,5 high-risk patients, tumor diameter:42 cases with 3 cm, and 57 cases of 3cm. There was no statistical difference in the general data of sex, age, stage, grade, number of tumor and tumor diameter in the two groups (P0.05). Among them,2 were T1G3, one case was T1G2, and one case was Ta G2. In the residual tumor,2 cases showed only a small residual of the substrate, and one case decreased from the G2 stage to the G1 level, and the stage of the pathological stage was not changed. In the two groups, there were 17 cases of recurrence and the recurrence rate was 13.81.re TUR group and 6 cases (11.1%), in which 2 cases recurred in situ,11 (15.9%) in the routine follow-up group and 2 in in-situ recurrences. It was found that the recurrence rate of the two groups was not statistically significant (P0.05). The result of single factor analysis related to the recurrence: the postoperative pathological stage, the grade, the number of the tumor, the prior recurrence rate and the risk stratification are the risk factors that affect the recurrence of the patient (P0.05), and whether the re-TUR, the sex, the age, the bladder perfusion drug are different, There was no correlation between the size of the tumor and the recurrence of the patients (P0.05). The results of multi-factor analysis related to the recurrence: the risk factors of the statistical significance in the single-factor analysis and the risk model for the introduction of re-TUR into the Cox proportional risk model showed that only the number of tumors was an independent risk factor that affected the recurrence of non-myometrial invasion of bladder cancer (P0.05). Other factors that affect the recurrence of the tumor are excluded, and whether the re-TUR has no effect on the recurrence of the patient's postoperative recurrence. Conclusion: The patients with NMIBC have a high recurrence rate after TURBT, and the main cause of high recurrence rate is the residual of the tumor. Therefore, complete and complete resection of the tumor tissue is an effective way to prevent the recurrence of NMIBC. The number of tumors is an independent risk factor that affects the recurrence of patients with non-myometrial invasion, and re-TUR is not significant in reducing the recurrence rate of non-myometrial invasive bladder cancer. clinically, the standard TURBT operation is performed, the operation level of the surgeon is improved, the communication with the pathologist is increased, the first TURBT quality can be improved, the residual of the tumor is reduced, the postoperative recurrence rate is reduced, So as to avoid unnecessary re TUR.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.14
[Abstract]:Objective: To study the effect and necessity of transurethral resection of the bladder for non-myometrial invasion. Methods: The clinical data of 123 patients with non-myometrial invasion of bladder cancer from January 2013 to December 2015 were retrospectively analyzed. According to whether they were re-TUR, there were 54 cases of re-TUR group and 69 cases of routine follow-up group. All patients were given immediate and follow-up bladder perfusion after operation, and the infusion drug was epirubicin or gemcitabine. The cystoscope reexamination was performed on a regular basis. By referring to the patient's clinical and pathological data, we know the residual and re-staging of the postoperative tumor in the re TUR group. All the patients were followed up by telephone, out-patient and re-examination records to understand the postoperative recovery and the recurrence of the patients. And the recurrence of the two groups of patients was compared. The factors influencing the recurrence of the tumor were analyzed by single factor and multi-factor analysis. The clinical and pathological data of all patients was complete, and the follow-up time of the patient was 6-48 months, and the median follow-up time was 26 months. The data and follow-up results of the patients were sorted, the database was established, and the statistical software SPSS17.0 was used for analysis. The single factor analysis was performed using the Kaplan-Meier method, and the Log rank test was used for the comparison among the different groups. The Cox proportional hazard model was used for the multi-factor analysis. The time of recurrence is the time of the patient's operation time to the tissue pathology to confirm the recurrence of the tumor. The difference of P0.05 was of statistical significance. Results:1. The basic case data of the two groups were as follows: in this study, there were 123 patients in this study, of which 69 received a single electrical cut and 54 received re-TUR.re TUR,46 male and 8 female, aged 20 to 76, with an average age of 58. There were 24 cases of single tumor,30 cases of multiple tumors,28 cases of Ta stage and 26 cases in T1 stage. Tumor classification: low grade 4 cases, medium grade 21 cases, high-level 29 cases. Risk stratification:49 cases of middle-risk patients,5 cases of high-risk patients,37 cases of tumor diameter, and 17 cases of 3cm. In the routine follow-up group,58 male and 11 female, aged 27 to 82, were 59 years of age. There were 35 cases of single tumor,34 cases of multiple tumors,42 cases of Ta and 27 in T1. Tumor classification: low grade 19 cases, medium grade 25 cases, high-level 25 cases. Risk classification:64 patients with intermediate risk,5 high-risk patients, tumor diameter:42 cases with 3 cm, and 57 cases of 3cm. There was no statistical difference in the general data of sex, age, stage, grade, number of tumor and tumor diameter in the two groups (P0.05). Among them,2 were T1G3, one case was T1G2, and one case was Ta G2. In the residual tumor,2 cases showed only a small residual of the substrate, and one case decreased from the G2 stage to the G1 level, and the stage of the pathological stage was not changed. In the two groups, there were 17 cases of recurrence and the recurrence rate was 13.81.re TUR group and 6 cases (11.1%), in which 2 cases recurred in situ,11 (15.9%) in the routine follow-up group and 2 in in-situ recurrences. It was found that the recurrence rate of the two groups was not statistically significant (P0.05). The result of single factor analysis related to the recurrence: the postoperative pathological stage, the grade, the number of the tumor, the prior recurrence rate and the risk stratification are the risk factors that affect the recurrence of the patient (P0.05), and whether the re-TUR, the sex, the age, the bladder perfusion drug are different, There was no correlation between the size of the tumor and the recurrence of the patients (P0.05). The results of multi-factor analysis related to the recurrence: the risk factors of the statistical significance in the single-factor analysis and the risk model for the introduction of re-TUR into the Cox proportional risk model showed that only the number of tumors was an independent risk factor that affected the recurrence of non-myometrial invasion of bladder cancer (P0.05). Other factors that affect the recurrence of the tumor are excluded, and whether the re-TUR has no effect on the recurrence of the patient's postoperative recurrence. Conclusion: The patients with NMIBC have a high recurrence rate after TURBT, and the main cause of high recurrence rate is the residual of the tumor. Therefore, complete and complete resection of the tumor tissue is an effective way to prevent the recurrence of NMIBC. The number of tumors is an independent risk factor that affects the recurrence of patients with non-myometrial invasion, and re-TUR is not significant in reducing the recurrence rate of non-myometrial invasive bladder cancer. clinically, the standard TURBT operation is performed, the operation level of the surgeon is improved, the communication with the pathologist is increased, the first TURBT quality can be improved, the residual of the tumor is reduced, the postoperative recurrence rate is reduced, So as to avoid unnecessary re TUR.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.14
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