基于TNM分期常规电切镜经尿道膀胱肿瘤剜除术的研究

杨晓峰; 田天亮; 刘晨; 张瑞; 赵红顺; 冷培俊; 王东文

doi:10.13201/j.issn.1001-1420.2019.06.010

基于TNM分期常规电切镜经尿道膀胱肿瘤剜除术的研究

- 1. 山西医科大学第一医院泌尿外科(太原, 030001);
- 2. 孝义市人民医院外科

详细信息

通讯作者: 杨晓峰,E-mail:yxfylq@163.com

中图分类号: R737.14

收稿日期: 2017-11-22

Study on en bloc resection of bladder tumours based on TNM classification system

- 1. Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, 030001, China;
- 2. Department of Surgery, People's Hospital of Xiaoyi

More Information

Corresponding author: YANG Xiaofeng, E-mail: yxfylq@163.com

Received Date: 22 November 2017

摘要

摘要: 目的:探讨基于膀胱癌(BC) TNM分期,采用常规电切镜和电切环行经尿道膀胱肿瘤整体剜除术(ERBT)的理论基础和手术方式。方法:2015年1月~2018年12月我院收治的210例非肌层浸润性膀胱肿瘤(NMIBC)患者为研究对象,按手术方式的不同,将其随机分为基于TNM分期常规电切镜经尿道膀胱肿瘤剜除术组(TNM-ERBT组)和常规经尿道膀胱肿瘤切除术组(cTURBT组)。TNM-ERBT组120例,年龄(54.63±12.07)岁;cTURBT组90例,年龄(55.43±11.67)岁。两组均采用常规电切镜和单极电切环进行,TNM-ERBT组的手术方式是从肿瘤基底近端正常黏膜处向肿瘤基底剜除,剜除深度依据肿瘤浸润的深度进行;cTURBT组采用常规手术方式。观察指标包括术前肿瘤临床分期和分级、术中肿瘤分期、术后病理分期和分级及术后6个月的复发率等。结果:TNM-ERBT组和cTURBT组术前临床资料比较差异无统计学意义。术中TNM-ERBT能够按照TNM分期进行肿瘤剜除,准确确定肿瘤浸润深度,正确评估预后。TNM-ERBT组和cTURBT组术后6个月复发率比较差异有统计学意义(13.3% vs.31.8%,P=0.001),且TNM-ERBT组原位复发率显著下降(P＜0.05)。结论:基于膀胱癌TNM分期进行ERBT是一种新的手术理念和手术方式。与cTURBT相比,TNM-ERBT能够通过术中分期,即刻明确有无肿瘤残余和预后评估,但尚需大规模临床研究来验证。
- 膀胱癌 /
- 经尿道膀胱肿瘤切除术 /
- TNM分期 /
- 术中实时分期 /
- 膀胱肿瘤剜除术
Abstract: Objective: We propose a novel theory and technique of real-time intraoperative staging of bladder tumour by using the ERBT according to tumour, node, metastasis classification (TNM-ERBT). Method: TNM-ERBT and conventional transurethral resection of bladder tumor (cTURBT) were conducted, respectively, in 120 and 90 patients who diagnosed with non-muscle invasive bladder cancer (NMIBC). TNM-ERBT was performed by using continuous flow resectoscope with monopolar electrode loop to coagulate and push form normal mucosa to base of tumour retrogradely according to the depth of tumor infiltration. Patients' clinicopathological characteristics, the data of perioperative tumour stage, intraoperative real-time staging of bladder tumours and follow-up data were observed. Result: Of the 210 patients, 120 underwent TNM-ERBT and 90 underwent cTURBT. Both groups were comparable with the perioperative data. TNM-ERBT could be performed as safely as cTURBT. There was no significant difference in operative time or surgical complications. Although the overall cumulative recurrence of TNM-ERBT and cTURBT were 13.3% and 31.8%, respectively (P=0.001), in situ recurrence significantly reduced in TNM-ERBT group (P＜0.05). T_a-T₁tumours do not require detrusor resection, while tumours of stage ＞T₂ require detrusor resection.Conclusion: TNM-ERBT is a novel technique of real-time intraoperative staging, and it can significantly reduce the in situ recurrence of bladder tumour. However, large-scale clinical verification is needed.
- bladder tumour /
- TURBT /
- TNM classification system /
- Intraoperative real-time staging /
- en-bloc resection of bladder tumour

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