摘要
目的探讨初次经尿道膀胱肿瘤电切术（transurethral resection of bladder tumor，TURBt）术后病理分期低估现象的可能原因，并提出相应的处理策略。方法回顾性分析2006年1月至2011年3月收治的118例初次TURBt术诊断为非肌层浸润性膀胱癌患者资料。男93例，女25例。年龄（63．0±8．6）岁。肿瘤位于侧壁71例，顶前壁23例，三角区和后壁24例；单发75例，多发43例；肿瘤直径0．5～4．0cm，平均2．0cm，其中≥3．0cm者39例；高、低年资医师分别手术53和65例。采用2004WHO／ISUP分级法和2002UICCTNM分期系统，将初次TURBt术后病理与二次电切（60例）或手术切除术后（58例）病理结果比较，采用x。检验和Logistic回归分析病理分期低估原因。结果118例初次TURBt病理分级分期为高分级T113例，高分级T161例，低分级T1 44例；二次电切、膀胱部分切除及根治术后病理：T1 8例，T174例，T2 36例，共低估39例（33．1％，P〈0．01），其中二次电切组被低估17例，手术切除组被低估22例。初次TURBt时组织形态人为改变63例（53．4％），组织标本中肌层缺失56例（47．5％）；采用Logistic回归分析发现肿瘤直径≥3．0cm、位于顶前壁／侧壁是标本中肌层缺失的危险因素，前者OR：3．766，95％CI1．263～11．225（P=0．017），后者OR：5．951，95％CI2．186～16．203（P〈0．001）；而高年资医师是标本中肌层呈现的保护因素，OR：0．274，95％C10．127～0．593（P=0．001）。结论初次TURBt术病理分期低估主要与电切后标本组织形态改态和肿瘤基底肌层缺失有关，通过有经验的高年资医生行TURBt术和二次电切可减少初次TURBt术存在的病理分期低估现象。
Objective To analyze the causes of under-staging in first transurethral resection of bladder tumor （TURBt） and find out solutions. Methods We retrospectively analyzed 118 cases （93 males and 25 females） of non-muscle invasive bladder cancer and compared the grade and stage between the first TURBt with the second transurethral resection （TUR） or partial cystectomy （PC） or radical cystectomy （RC） from January 2006 to March 2011. The mean patient age was 63.0 ＋ 8.6 yrs. The tumors located in lateral, dome and posterior wall were 71 , 23, 24 respectively ; 75 of them were with single and 43 were with muhifocal lesions ; the sizes of tumor ranged from 0.5 - 4.0 cm and 39 of them were t〉 3.0 cm ; The procedures performed by senior and junior urologist were 53 and 65 cases, respectively. In the study, we used the 2004 WHO/ISUP and 2002 TNM classification system for grading and staging. The data were analyzed with X^2 and the logistic regression test to find out the causes of under-staging in first TURBt. Results There were 13 and 105 cases with high-grade T and T1 （low-grade T1 44 cases, high-grade T161 cases） in first TURBt, respectively. The finial stages were low-grade T（2） , high-grade Ta（6） , low-grade T1 （36） , high-gradeT1（38）, T2（36） and 39 cases （33.1%） were under staged （P〈0.01）. There were 17 and 22 under-staged cases compared with the second-TUR group （60 cases） and PC/RC groups （58 cases） , respectively. The reasons of under-staging were related to tissue morphology changes （63 cases） and the absence of the detrusor muscle （56 cases） in specimens collected during the first TURBt. Multivariate analyses revealed that large tumors （ I〉 3 cm） , and lateral/dome/anterior wall tumors were independent risk factors to the absence of the detrusor muscle in the resected specimens with OR （95% CI） ： 3. 766 （ 1. 263 - 11. 225）, and OR （95% CI） ： 5. 951 （2. 186 - 16. 203 ）, respectively. While surgery performed by senior
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第6期434-438,共5页
Chinese Journal of Urology
基金
广东省科技计划基金（2008B030301314）
