本文關(guān)鍵詞： 膀胱尿路上皮癌 熒光原位雜交技術(shù) 尿脫落細胞學 膀胱鏡 診斷 復(fù)發(fā)　出處：《華中科技大學》2016年博士論文　論文類型：學位論文

【摘要】：目的比較熒光原位雜交技術(shù)(FISH)檢查、尿脫落細胞學檢查和膀胱鏡檢查對于膀胱尿路上皮癌患者的診斷價值,以及三種檢查對于監(jiān)測膀胱尿路上皮癌患者術(shù)后復(fù)發(fā)的診斷價值,為完善膀胱尿路上皮癌患者的診斷策略提供理論基礎(chǔ)。方法第一部分：因血尿或其他相關(guān)臨床癥狀就診的2478例可疑膀胱尿路上皮癌患者,完善熒光原位雜交技術(shù)(FISH)檢查、尿脫落細胞學檢查和膀胱鏡檢查,并以術(shù)后病理檢查診斷結(jié)果為“金標準”,分別比較三種檢查診斷膀胱尿路上皮癌總的敏感性和特異性,以及對于不同膀胱腫瘤分期的患者,比較三種檢查在不同膀胱腫瘤分期中診斷的敏感性差異。第二部分：82例確診為膀胱尿路上皮癌的患者,行經(jīng)尿道膀胱腫瘤切除術(shù)(TURBT),分別在術(shù)后3個月、6個月、9個月和12個月于我院復(fù)診,每次復(fù)診時完善熒光原位雜交技術(shù)(FISH)檢查、尿脫落細胞學檢查和膀胱鏡檢查,分別比較三種檢查在每個復(fù)診時間點的陽性結(jié)果檢出率,以及三種檢查陽性結(jié)果平均檢出時間的差異,和FISH技術(shù)檢查結(jié)果陽性對于判斷膀胱尿路上皮癌患者復(fù)發(fā)的價值。結(jié)果第一部分：在2478名可疑膀胱尿路上皮癌的患者中,熒光原位雜交技術(shù)(FISH)檢查、尿脫落細胞學檢查和膀胱鏡檢查總的敏感性分別為80.81%、26.65%、88.27%,分別比較三種檢查總的敏感性,均存在顯著差異,具有統(tǒng)計學意義。FISH技術(shù)檢查、尿脫落細胞學檢查和膀胱鏡檢查總的特異性分別為90.20%、95.71%、85.66%,分別比較三種檢查總的特異性,均存在顯著差異,具有統(tǒng)計學意義。熒光原位雜交技術(shù)(FISH)檢查在膀胱尿路上皮癌患者的不同腫瘤分期中,診斷的敏感性分別為Ta期66.96%、T1期78.69%、T2期84.99%、T3/4期98.92%,尿脫落細胞學檢查在不同腫瘤分期中診斷的敏感性分別為Ta期6.09%、T1期16.98%、T2期40.46%、T3/4 67.57%,膀胱鏡檢查在不同腫瘤分期中診斷的敏感性分別為Ta期71.30%、T1期85.25%、T2期99.24%、T3/4期100.00%。Ta期膀胱尿路上皮癌患者的診斷,FISH技術(shù)檢查與膀胱鏡檢查不存在顯著差異,其余兩組比較存在顯著差異。T1期、T2期膀胱尿路上皮癌患者的診斷,三種檢查的敏感性均存在顯著差異,膀胱鏡檢查的敏感性最高。T3/4期膀胱尿路上皮癌患者的診斷結(jié)果比較與Ta期相同,FISH技術(shù)檢查與膀胱鏡檢查不存在顯著差異,其余兩組比較存在顯著差異。第二部分：在82名確診為膀胱尿路上皮癌的術(shù)后患者中,熒光原位雜交技術(shù)(FISH)檢查在四個復(fù)診時間點的陽性結(jié)果檢出率分別為術(shù)后3個月0%、術(shù)后6個月2.44%、術(shù)后9個月6.10%、術(shù)后12個月4.88%,尿脫落細胞學檢查在四個復(fù)診時間點的陽性結(jié)果檢出率分別為術(shù)后3個月0%、術(shù)后6個月0%、術(shù)后9個月1.22%、術(shù)后12個月2.44%,膀胱鏡檢查在四個復(fù)診時間點的陽性結(jié)果檢出率分別為術(shù)后3個月0%、術(shù)后6個月0%、術(shù)后9個月2.44%、術(shù)后12個月2.44%。FISH技術(shù)檢查、尿脫落細胞學檢查和膀胱鏡檢查的陽性結(jié)果平均檢出時間分別為(9.55±2.25)個月、(11.00±1.73)個月、(10.50±1.73)個月。FISH技術(shù)檢查與另外兩種檢查方式的陽性結(jié)果平均檢出時間比較存在差異,比尿脫落細胞學檢查和膀胱鏡檢查的平均檢出時間更短。在術(shù)后一年的隨訪過程中,共有4名患者確定復(fù)發(fā),腫瘤分期與首次手術(shù)時相比沒有進展,其中2例是膀胱癌分期為T2期的患者,占11例T2期術(shù)后患者的18.18%,均于術(shù)后9個月復(fù)發(fā),另外2例是膀胱癌分期為T1期的患者,占56例T1期術(shù)后患者的3.57%,術(shù)后12個月復(fù)發(fā),Ta期膀胱癌患者未見復(fù)發(fā)。4名確定膀胱癌復(fù)發(fā)的患者,FISH技術(shù)檢查結(jié)果均為陽性。結(jié)論目前,膀胱鏡檢查依然是膀胱尿路上皮癌的術(shù)前診斷和術(shù)后復(fù)發(fā)監(jiān)測的“金標準”。熒光原位雜交技術(shù)(FISH)檢查對于膀胱尿路上皮癌患者的診斷具有很高的敏感性和特異性,尤其可以作為早期篩查膀胱尿路上皮癌一種檢查方式。無論是膀胱尿路上皮癌的診斷,還是術(shù)后復(fù)發(fā)監(jiān)測,當FISH技術(shù)檢查陽性而膀胱鏡檢查陰性時,需要更加密切的進行隨訪,警惕膀胱腫瘤的發(fā)生。尿脫落細胞學檢查對于膀胱尿路上皮癌患者的診斷敏感性較低,僅作為其他檢查的輔助檢查。
[Abstract]:Comparison of fluorescence in situ hybridization (FISH) objective examination, urine cytology and cystoscopy for the diagnosis of bladder urothelial carcinoma patients, and three kinds of check value for diagnosis of recurrence patients monitoring of bladder urothelial carcinoma, and provide a theoretical basis for improvement of diagnostic strategies of bladder urothelial carcinoma patients. Methods: in the first part, from 2478 cases of suspected bladder urothelial cancer hematuria or other related clinical symptoms, improve the fluorescence in situ hybridization (FISH) examination, urine cytology and cystoscopy, and postoperative pathological diagnosis results as gold standard, to compare the three diagnostic sensitivity and the specificity of urothelial carcinoma of the bladder and the bladder tumor staging for different patients, comparison of three kinds of examination in the early diagnosis of bladder cancer in different stages of sensitivity difference. Second Part: 82 cases of bladder urothelial carcinoma patients underwent transurethral resection of bladder tumor (TURBT), 3 months respectively after operation, 6 months, 9 months and 12 months in our hospital visit, at every visit to improve the fluorescence in situ hybridization (FISH) examination, urine cell examination and cystoscopy, compare the three check positive results in the time of each visit the detection rate, and three positive results check the average detection time difference value of positive and FISH examination results for diagnosis of bladder urothelial cancer recurrence. Results: in the first part of the 2478 suspected bladder urothelial carcinoma patients, fluorescence in situ hybridization (FISH) examination, urine cytology and cystoscopy total sensitivity were 80.81%, 26.65%, 88.27%, respectively. The sensitivity comparison of three check the total, there are significant differences statistically Significance of.FISH examination, urine cytology and cystoscopy total specificity were 90.20%, 95.71%, 85.66% respectively, the specificity three examination, there were significant differences, with statistical significance. The fluorescence in situ hybridization (FISH) were examined in different tumor bladder urothelial cancer staging in the sensitivity of diagnosis were Ta stage 66.96%, T1 stage 78.69%, T2 stage 84.99%, T3/4 stage 98.92%, urine cytology in the staging of different sensitivity of tumor diagnosis were Ta 6.09%, T1 16.98%, T2 40.46%, T3/4 67.57%, cystoscopy in the staging of different sensitivity of tumor diagnosis respectively. Ta stage 71.30%, T1 stage 85.25%, T2 stage 99.24%, T3/4 stage 100.00%.Ta diagnosis of bladder urothelial carcinoma patients, FISH examination and cystoscopy and there is no significant difference between the other two groups were compared, there was significant difference in.T1, T2 The diagnosis of bladder urothelial carcinoma patients, sensitivity of three kinds of examination were significantly different, the highest.T3/4 sensitivity in the diagnosis of urothelial carcinoma were cystoscopy results compared with Ta at the same time, FISH examination and cystoscopy there is no significant difference between the other two groups there were significant differences in second. Part: in the 82 patients diagnosed as bladder urothelial carcinoma after operation, fluorescence in situ hybridization (FISH) examination in the positive results of the four time points were respectively 3 months after surgery, 0%, 6 months after surgery, 2.44%, 9 months after surgery, postoperative 6.10%, 12 4.88% months, urine cytology positive results in the four follow-up time points were detected in 3 months after surgery, 0%, 6 months after surgery, 0%, 9 months after surgery, 1.22%, 12 months after surgery, 2.44%, cystoscopy in the positive results of the four time points of the detected rate of return respectively. For operation 鍚，

本文編號：1494720