中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2012年
6期
434-438
,共5页
黄洁夫%湛海伦%杨飞%卢扬柏%周祥福
黃潔伕%湛海倫%楊飛%盧颺柏%週祥福
황길부%담해륜%양비%로양백%주상복
经尿道膀胱肿瘤电切术%分期低估%逼尿肌层
經尿道膀胱腫瘤電切術%分期低估%逼尿肌層
경뇨도방광종류전절술%분기저고%핍뇨기층
Transurethral resection%Under-staging%Detrussr muscle
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 ～4.0 cm,平均2.0 cm,其中≥3.0 cm者39例;高、低年资医师分别手术53和65例.采用2004 WHO/ISUP分级法和2002 UICC TNM分期系统,将初次TU RBt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x2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Ta13例,高分级T161例,低分级T144例;二次电切、膀胱部分切除及根治术后病理:Ta8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≥3.0 cm、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％ CI 1.263～11.225(P=0.017),后者OR:5.951,95％ CI 2.186～16.203(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％CI0.127～0.593(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TU RBt术存在的病理分期低估现象.
目的 探討初次經尿道膀胱腫瘤電切術( transurethral resection of bladder tumor,TURBt)術後病理分期低估現象的可能原因,併提齣相應的處理策略.方法 迴顧性分析2006年1月至2011年3月收治的118例初次TURBt術診斷為非肌層浸潤性膀胱癌患者資料.男93例,女25例.年齡(63.0±8.6)歲.腫瘤位于側壁71例,頂前壁23例,三角區和後壁24例;單髮75例,多髮43例;腫瘤直徑0.5 ～4.0 cm,平均2.0 cm,其中≥3.0 cm者39例;高、低年資醫師分彆手術53和65例.採用2004 WHO/ISUP分級法和2002 UICC TNM分期繫統,將初次TU RBt術後病理與二次電切(60例)或手術切除術後(58例)病理結果比較,採用x2檢驗和Logistic迴歸分析病理分期低估原因.結果 118例初次TURBt病理分級分期為高分級Ta13例,高分級T161例,低分級T144例;二次電切、膀胱部分切除及根治術後病理:Ta8例,T174例,T2 36例,共低估39例(33.1％,P＜0.01),其中二次電切組被低估17例,手術切除組被低估22例.初次TURBt時組織形態人為改變63例(53.4％),組織標本中肌層缺失56例(47.5％);採用Logistic迴歸分析髮現腫瘤直徑≥3.0 cm、位于頂前壁/側壁是標本中肌層缺失的危險因素,前者OR:3.766,95％ CI 1.263～11.225(P=0.017),後者OR:5.951,95％ CI 2.186～16.203(P ＜0.001);而高年資醫師是標本中肌層呈現的保護因素,OR:0.274,95％CI0.127～0.593(P=0.001).結論 初次TURBt術病理分期低估主要與電切後標本組織形態改態和腫瘤基底肌層缺失有關,通過有經驗的高年資醫生行TURBt術和二次電切可減少初次TU RBt術存在的病理分期低估現象.
목적 탐토초차경뇨도방광종류전절술( transurethral resection of bladder tumor,TURBt)술후병리분기저고현상적가능원인,병제출상응적처리책략.방법 회고성분석2006년1월지2011년3월수치적118례초차TURBt술진단위비기층침윤성방광암환자자료.남93례,녀25례.년령(63.0±8.6)세.종류위우측벽71례,정전벽23례,삼각구화후벽24례;단발75례,다발43례;종류직경0.5 ～4.0 cm,평균2.0 cm,기중≥3.0 cm자39례;고、저년자의사분별수술53화65례.채용2004 WHO/ISUP분급법화2002 UICC TNM분기계통,장초차TU RBt술후병리여이차전절(60례)혹수술절제술후(58례)병리결과비교,채용x2검험화Logistic회귀분석병리분기저고원인.결과 118례초차TURBt병리분급분기위고분급Ta13례,고분급T161례,저분급T144례;이차전절、방광부분절제급근치술후병리:Ta8례,T174례,T2 36례,공저고39례(33.1％,P＜0.01),기중이차전절조피저고17례,수술절제조피저고22례.초차TURBt시조직형태인위개변63례(53.4％),조직표본중기층결실56례(47.5％);채용Logistic회귀분석발현종류직경≥3.0 cm、위우정전벽/측벽시표본중기층결실적위험인소,전자OR:3.766,95％ CI 1.263～11.225(P=0.017),후자OR:5.951,95％ CI 2.186～16.203(P ＜0.001);이고년자의사시표본중기층정현적보호인소,OR:0.274,95％CI0.127～0.593(P=0.001).결론 초차TURBt술병리분기저고주요여전절후표본조직형태개태화종류기저기층결실유관,통과유경험적고년자의생행TURBt술화이차전절가감소초차TU RBt술존재적병리분기저고현상.
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 multifocal lesions; the sizes of tumor ranged from 0.5 -4.0 cm and 39 of them were ≥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 x2 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 Ta and T1 (low-grade T1 44 cases,high-grade T1 61 cases) in first TURBt,respectively.The finial stages were low-grade Ta(2),high-grade Ta(6),low-grade T1 (36),highgrade T1 ( 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 ( ≥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 surgeons was the protective factor to the presence of detrusor muscle,OR (95％ CI):0.274 (0.127 -0.593). Conclusions It is difficult for the first TURBt to completely avoid under-staging.The causes were related to tissues morphology changes and the absence of underlying detrusor muscle in specimens collected during the first TURBT procedure.Tissues morphology changes and the absence of detrusor muscle are related to the tumors location and size.A senior urologist and second-TUR can improve the under-staging.
