经尿道二次电切术治疗非肌层浸润性膀胱癌的临床分析
发布时间：2019-06-04 08:58
【摘要】：目的:探讨经尿道二次电切术治疗非肌层浸润性膀胱癌的疗效及必要性。方法:回顾性统计分析自2013年1月至2015年12月就诊于天津市肿瘤医院的123例行经尿道膀胱肿瘤切除术后病理证实为非肌层浸润性膀胱癌患者的临床病例资料特点。根据是否行re TUR,分为re TUR组54例和常规随访组69例。所有患者术后均给予即刻及后续膀胱灌注治疗,灌注药物为表柔比星或吉西他滨。术后定期进行膀胱镜复查。通过查阅患者临床病例及病理资料,了解re TUR组患者术后肿瘤残余及重新分期情况,所有患者通过电话、门诊病例及复查记录进行随访,了解患者术后恢复以及有无复发情况,并将两组患者的复发情况进行比较。并对影响肿瘤复发的各因素进行单因素和多因素统计分析。所有患者的临床病例及病理资料完整,患者随访时间为6~48个月,中位随访时间为26个月。将患者的资料及随访结果进行整理,建立数据库,应用统计学软件SPSS17.0进行分析,单因素分析采用Kaplan-Meier法,不同组间比较采用Log rank检验,多因素分析采用Cox比例风险模型。复发时间为患者手术时间至组织病理学证实肿瘤复发的时间。以P0.05为差异具有统计学意义。结果:1.两组患者的基本病例资料特点:本研究共123例患者,其中69例接受单次电切,54例接受re TUR。re TUR组患者中,男性46例,女性8例,年龄20~76岁,平均58岁。单发肿瘤24例,多发肿瘤30例,临床分期:Ta期28例,T1期26例。肿瘤分级:低级别4例,中级别21例,高级别29例。危险度分层:中危患者49例,高危患者5例,肿瘤直径:≤3cm者37例,3cm者17例。常规随访组患者中,男性58例,女性11例,年龄27~82岁,平均59岁。单发肿瘤35例,多发肿瘤34例,临床分期:Ta期42例,T1期27例。肿瘤分级:低级别19例,中级别25例,高级别25例。危险度分级:中危患者64例,高危患者5例,肿瘤直径:≤3cm者42例,3cm者57例。两组患者的性别、年龄、分期、分级、肿瘤数目、肿瘤直径等一般资料均无统计学差异(P0.05)。2.re TUR组患者肿瘤残余情况:54例接受re TUR的患者中,4例出现肿瘤残余,肿瘤残余率为7.4%。其中2例为T1G3,1例为T1G2,1例为Ta G2。残余肿瘤中,2例病理提示仅基底少量残留,1例由G2级降至G1级,1例病理分期分级不变。3.两组患者复发情况比较:截止随访时间,共17例患者出现复发,复发率为13.8%。re TUR组复发6例(11.1%),其中原位复发2例;常规随访组复发11例(15.9%),原位复发2例。通过比较发现两组患者复发率差异没有统计学意义(P0.05)。4.与复发相关的单因素分析结果:术后病理分期、分级、肿瘤数目、既往复发率和危险分层是影响患者复发的危险因素(P0.05),而是否行re TUR、性别、年龄、膀胱灌注药物的不同、肿瘤大小等与患者复发无相关性(P0.05)。5.与复发相关的多因素分析结果:将单因素分析中有统计学意义的危险因素和是否行re TUR导入Cox比例风险模型,结果显示,只有肿瘤数目是影响非肌层浸润性膀胱癌患者复发的独立危险因素(P0.05)。排除影响肿瘤复发的其他因素,是否行re TUR对患者术后复发无影响。结论:NMIBC患者TURBT术后具有较高复发率,导致高复发率的主要原因是肿瘤残余。因此,完全、彻底地切除肿瘤组织是预防NMIBC复发的有效方式。肿瘤数目是影响患者复发的独立危险因素,而re TUR对降低非肌层浸润性膀胱癌患者的复发率没有显著意义,因此行re TUR的必要性还有待进一步探讨。在临床上,进行规范的TURBT手术操作,提高手术医师的操作水平,增加与病理医师的沟通,术后即刻膀胱灌注化疗及维持灌注,联合新技术等可以提高首次TURBT质量,减少肿瘤残余,降低术后复发率,从而避免不必要的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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14
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