两种保留膀胱手术方式治疗肌层浸润性膀胱癌的疗效分析

发布时间：2018-03-16 09:14

本文选题：肌层浸润性膀胱癌　切入点：膀胱部分切除术　出处：《延边大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:评价两种保留膀胱的不同手术方式治疗肌层浸润性膀胱癌的临床疗效,探讨两种术式对预后的影响因素。方法:收集2009年1月至2013年10月在延边大学附属医院泌尿外科住院的患者,采用经尿道膀胱肿瘤电切术(Transurethral resection of bladder tumor,TURBT)和膀胱部分切除术(Partial cystectomy,PC)治疗肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)病例共 84 例,分为 PC 组49 例(T231 例,T314例,T44例)和 TURBT 组 35 例(T231 例,T34 例,T40 例)。全部患者进行术后随访3年。比较2种手术方式、手术时间、术中出血量、留置导尿管时间、住院时间、并发症和3年复发率,并分析两种手术方式与生存相关的预后因素。结果:PC组与TURBT组患者平均住院日期、手术时间、术中出血量及留置导尿管时间均有的统计学差异(均P0.05),而并发症及3年复发率无统计差异(P0.05)。PC组与TURBT组中与肿瘤生存相关的独立危险因素是肿瘤的病理分期(B值分别为1.459与1.900)。MIBC与肿瘤生存相关的独立危险因素为肿瘤的病理分期和肿瘤数量(B值1.058,1.454);3年随访期间PC组和TURBT组死于膀胱癌各为14例(71.4%)和10例(71.4%),两组T3患者3年肿瘤特异生存率(Cancerspecific survival,CSS)分别为 50%和0%(P=0.036)。结论:保留膀胱手术TURBT更适合T2患者,而PC更适合T3-4患者,两组的肿瘤病理分期是影响预后的独立危险因素;肿瘤分期越高,手术危险性更大,生存率越低;而分期越低,越适合做保留膀胱手术。
[Abstract]:Objective: to evaluate the clinical efficacy of two different bladder preserving surgical methods in the treatment of myometrial invasive bladder cancer. Methods: from January 2009 to October 2013, we collected the patients hospitalized in the Urology Department of Yanbian University affiliated Hospital. Transurethral resection of bladder tumor TURBT (transurethral resection of bladder tumor TURBT) and partial cystectomy (partial cystectomy) were performed in 84 cases of muscle-invasive bladder carcinoma of bladder cancer. The patients were divided into PC group (n = 49) and TURBT group (n = 35) and TURBT group (n = 35). All patients were followed up for 3 years. The complications and the recurrence rate of 3 years were analyzed, and the prognostic factors related to survival were analyzed. Results the average hospitalization date and operation time of the patients in the TURBT group and the PC group were analyzed. There were statistical differences in intraoperative bleeding volume and indwelling catheter time (all P 0.05), but there was no statistical difference in complications and recurrence rate of 3 years. The independent risk factors related to tumor survival in PC group and TURBT group were the pathological staging and B score of tumor. The independent risk factors related to tumor survival were tumor pathological stage and tumor number (B = 1.058 / 1.454g, respectively, 14 patients died of bladder cancer in PC group and TURBT group (n = 14)) and 10 patients died from bladder cancer (n = 10) and 10 patients in group T _ 3 (n = 10). The tumor was specific for three years in both groups of T3 patients. The survival rate was 50% and 0 respectively. Conclusion: preserving TURBT for bladder surgery is more suitable for T2 patients. PC is more suitable for T3-4 patients. Tumor pathological staging is an independent risk factor for prognosis in both groups. The higher the tumor stage is, the greater the surgical risk is, and the lower the survival rate is; the lower the staging, the more suitable for bladder preservation surgery.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14

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