多发性膀胱癌二次电切治疗的疗效观察研究（附10例报告并文献复习）

发布时间：2018-06-24 03:27

本文选题：膀胱癌 + 经尿道膀胱肿瘤电切术　；参考：《福建医科大学》2014年硕士论文

【摘要】：【目的】经尿道二次电切术（repeattransurethral resection,ReTUR）（以下称为ReTUR）作为治疗膀胱癌的一项技术，对其可行性及有效性尚未得到一致认同。本文通过对我院10例经二次电切治疗的多发膀胱癌患者进行研究，探讨膀胱癌二次电切的适应症、注意要点及预后等，进一步了解二次电切的临床意义。【方法】回顾分析2011年1月至2013年12月我院收治并行ReTUR手术治疗的患者共10例，其中9例为非肌层浸润性膀胱癌，1例为首次行TURBT术后复发并进展为肌层浸润性膀胱癌。所有病例均为多发，均采用经尿道膀胱肿瘤电切术（transurethral resection of bladder tumor,TURBT）（以下称为TURBT）进行治疗，均于TURBT术后4-6周后再行ReTUR。首次电切及二次电切术后均于术后7天开始行膀胱内灌注化疗，每周一次，共8周；8周后改为每月1次，持续1-2年。术后每3个月进行膀胱镜检查一次，持续1年改为每半年一次，随访记录患者的肿瘤复发及进展情况。【结果】10例患者均已病理证实为膀胱癌，随访时间为6-39个月。7例无瘤存活，时间分别为6-39个月，平均时间约为15个月；1例于二次电切术后9个月发现肿瘤复发，予再次行TURBT联合GC（吉西他滨和顺铂）方案全身化疗1周期，6个月后再次发现肿瘤复发，再次行TURBT治疗后存活；2例分别于二次电切术后8个月及12个月死亡。【结论】①非肌层浸润性膀胱癌的主要治疗手段仍为经尿道膀胱肿瘤电切术联合膀胱内灌注化疗等治疗，但该治疗方式复发率仍较高，而二次电切术能有效降低术后肿瘤复发率、控制疾病进展、延缓肿瘤复发。②对于多发性膀胱癌及部分肌层浸润性膀胱癌，，如果患者不愿行全膀胱切除术或全身情况不足以支持全膀胱切除术，在严格掌握适应症的条件下，可以采用二次电切术联合膀胱灌注化疗治疗或全身化疗的方式，具有一定的治疗效果。
[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.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

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