CAJ | 학술논문

目的：探讨首次经尿道膀胱肿瘤切除术（ TURBT）的诊断价值及其相关影响因素。方法回顾分析112例初步诊断为非肌层侵润性膀胱癌患者的临床资料，首次TURBT切除肿瘤并确定病理结果，与术后2～6周二次电切术（93例）、部分切除术（9例）和根治切除术（10例）病理结果进行比较。结果首次TURBT切除标本组织形态人为改变23例（20.54％），标本组织肌层缺失35例（31.25％）。比较发现，首次TURBT后肿瘤残余47例（41.96％），病理结果一致84例（75.00％），病理被低估28例（25.00％）。肿瘤进展风险、肿瘤位置、电切方法和术者经验与首次TURBT肿瘤残余有关（ P＜0.05）；Logistic分析得出影响首次TURBT肿瘤残余的因素依次为：肿瘤进展风险＞电切方法＞术者经验＞肿瘤位置；电切方法、术者经验与标本组织肌层缺失有关（P＜0.05）；电切设备与标本组织形态改变有关（P＜0.05）；标本肌层缺失、标本组织形态改变与首次TURBT病理结果正确率有关（ P＜0.05）。结论首次TURBT存在肿瘤残余、病理低估等缺陷，主要原因是无法保证高质量的TURBT并留取符合要求的标本，提倡有经验的医师通过双极等离子电刀系统来进行诊断性TURBT，对于高危膀胱肿瘤二次TURBT是有必要的。
목적：탐토수차경뇨도방광종류절제술（ TURBT）적진단개치급기상관영향인소。방법회고분석112례초보진단위비기층침윤성방광암환자적림상자료，수차TURBT절제종류병학정병리결과，여술후2～6주이차전절술（93례）、부분절제술（9례）화근치절제술（10례）병리결과진행비교。결과수차TURBT절제표본조직형태인위개변23례（20.54％），표본조직기층결실35례（31.25％）。비교발현，수차TURBT후종류잔여47례（41.96％），병리결과일치84례（75.00％），병리피저고28례（25.00％）。종류진전풍험、종류위치、전절방법화술자경험여수차TURBT종류잔여유관（ P＜0.05）；Logistic분석득출영향수차TURBT종류잔여적인소의차위：종류진전풍험＞전절방법＞술자경험＞종류위치；전절방법、술자경험여표본조직기층결실유관（P＜0.05）；전절설비여표본조직형태개변유관（P＜0.05）；표본기층결실、표본조직형태개변여수차TURBT병리결과정학솔유관（ P＜0.05）。결론수차TURBT존재종류잔여、병리저고등결함，주요원인시무법보증고질량적TURBT병류취부합요구적표본，제창유경험적의사통과쌍겁등리자전도계통래진행진단성TURBT，대우고위방광종류이차TURBT시유필요적。
Objective To investigate the diagnostic value and influencing factors of the first transurethral re -section of bladder tumor(TURBT).Methods The clinical data was retrospectively analyzed on 112 cases of non-muscle invasive bladder cancer , pathological results of bladder cancer were determined by the first TURBT , and then the pathological results were compared between the first TURBT and the second transurethral resection (93 cases) or partial cystectomy(9 cases) or radical cystectomy (10 cases) after 2 to 6 weeks.Results The tissue morphology changes were found in 23 patients and the absence of the detrusor muscle in 35 patients,relying on the specimens col-lected during the first TURBT .After first TURBT tumor residues were found in 47 patients , and the pathological re-sults were identical in 84 patients and were under-staging in 28 patients by comparison .The risk of tumour progres-sion,the tumor locations ,the method of transurethral resection and the operator′s experience were apparently related to tumor residues after first TURBT(P<0.05).The degree of relevance was as follows ,from more to less,by logistic re-gression analysis:the risk of tumour progression ,the method of transurethral resection ,the operator′s experience,the tumor locations .The method of transurethral resection and the operator′s experience were apparently related to the specimens lacked muscle tissue ( P<0.05 ) .The transurethral device were apparently related to tissue morphology changes.The specimens lacked muscle tissue and the tissue morphology changes were apparently related to pathologi -cal results from the first TURBT ( P<0.05 ) .Conclusion There are still shortcomings with the first TURBT ,such as the high rate of tumor residue and pathological underestimate ,the poor quality of specimens .A experienced urologist is advocated to adopt the diagnostic TURBT by bipolar plasmakinetic scalpel system .It is necessary for high-risk tumors to receive a second TURBT .