浅表性膀胱癌经尿道电切术后复发的原因和预防策略.docVIP

浅表性膀胱癌经尿道电切术后复发的原因及预防策略 林国太，李昌桂，张益明，邹智聪，刘英发，林元田，吴银锁 （351100 福建 莆田，福建医科大学莆田市第一医院教学医院泌尿外科） [摘要] 目的 探讨浅表性膀胱癌（STCC）经尿道肿瘤电切术（TURBt）后复发的原因及预防策略。方法 随机选取我院2001年1月-2007年6月收治的128例STCC患者作为对照组行TURBt术后丝裂霉素C膀胱灌注化疗， 另取2007年7月-2011年12月81例作为观察组行TURBt术后丝裂霉素C+干扰素联合膀胱灌注化疗，采取回顾性分析法对其肿瘤复发情况、化疗方案、手术操作规范等方面进行分析和总结，并结合文献对其术后复发的原因及预防措施进行了讨论。结果 209例手术后获随访（31±3）个月，总复发率28.23%，有12例术后病理分期分级进展。其中观察组肿瘤复发率14.15%、对照组36.72%，单发肿瘤23.23%、多发42.59%，Ta期6.25%、T1期34.78%，G1级17.05%、G2级37.25%、G3级62.07%。观察组获得肿瘤分期、分级、数目等情况与对照组无明显差异（Ｐ＞0.0５），但观察组肿瘤复发率较对照组低（P＜0.01）；单发、Ta期、低级别的肿瘤的复发率分别较多发、T1期、高级别的肿瘤低（Ｐ＜0.01）。结论 STCC经尿道电切术后复发主要原因是：肿瘤高分级及高分期，肿瘤多发性及非乳头状，肿瘤基底电切深度及范围不够，肿瘤周围存在肉眼难以发觉的隐性卫星病灶及人为因素遗漏小肿瘤，膀胱内残留肿瘤组织碎片种植，灌注化疗失败等。规范化彻底性切除肿瘤原发病灶，术后即刻开始联合应用化学药物及免疫生物制剂规范化膀胱灌注化疗，可提高临床疗效，降低复发率。 [关键词] 浅表性膀胱癌；经尿道电切；术后复发 [中图法分类号] [文献标志码] A [通信作者] 林国太，E-mail:ptlgt@163.com The high risks of post-TUR neoplasm recurrences for superficial transitional cell carcinoma（STCC）patients and a precautionary strategy Lin Guotai, Li Changui, Zhang Yiming, Zou Zhicong, Liu Yingfa, Lin Yuantian, Wu Yinsuo (Department Of Urology, Putian Municipal First Hospital, Teaching Hospital Of Fujian Medical University, Putian, 351100, Fujian, China) Abstract： Objectves To discuss the high risks and precautionary strategy of neoplasm recurrences after transurethral resection (TUR) for patients with superficial transitional cell carcinoma (STCC). Methods From Jan 2001 to June 2007, 128 randomly selected STCC patients who had undergone a TUR in our hospital, received vesical irrigative chemotherapy merely with Mutamycin C after surgery, were considered as the control group. Another series of 81 STCC patients in our hospital from July 2007 to Dec 2007 were selected as the observation group, these patients received vesical irrigative chemotherapy with mutamycin C, as well as interferon after TUR. Of all patients, clinical data such as neoplasm recurrence, chemotherapy schemes and operative procedures, etc. was analysed and summarized. Subsequently, a discu