薛亚岗　缪惠东　侯建华　顾红星　沈锋　袁晓林　刘海涌

[摘要] 目的 比较根治性膀胱切除术与经尿道电切术在治疗肌层浸润性膀胱癌的疗效，分析影响患者预后的危险因素。 方法 整群选取2005年1月—2012年10月于该院泌尿外科诊治的肌层浸润性膀胱癌患者69例，其中33例患者行尿道电切治疗（电切组），术后给予静脉、 膀胱灌注化疗，36例行根治性膀胱切除术（根治组），术后给予静脉化疗。对患者进行为期3年的随访，比较两组的手术时间、 术中失血量、 累积住院时间、 肿瘤3年无复发生存率（RFS）、3 年存活率（OS）等。行Log-rank 单因素和 Cox 多因素回归分析潜在危险因素。 结果 与根治组相比，电切组在手术时间、失血量以及住院时间上明显少于对照组，差异具有统计学意义（t=-22.020、-18.393、-7.205，P<0.01）；两组患者在复发率及3年存活率上差异无统计学意义（χ2=0.338、0.361，P>0.05）；Log-rank 单因素分析显示，肿瘤直径≥5 cm及T 3 期患者的预后较差，为3年RFS及OS的危险因素（χ2=8.183、21.548、8.427、12.410，P<0.01）；进一步行Cox 多因素分析，肿瘤直径≥5 cm为术后患者3年RFS的危险因素（RR=3.658，95%CI： 1.875～7.137，P<0.01），T 3 期和肿瘤直径≥5 cm 为影响患者3年OS的危险因素（P<0.01）。 结论 经尿道膀胱肿瘤电切术的手术风险较小，联合辅助静脉、膀胱灌注化疗能够到良好的治疗效果，肿瘤直径≥5 cm、T3期是影响膀胱癌患者预后的重要危险因素。

[关键词] 根治性膀胱癌切除术；经尿道电切术； 膀胱肿瘤；预后

[中图分类号] R737 [文献标识码] A [文章编号] 1674-0742（2016）02（b）-0021-03

[Abstract] Objective To compare the efficacy between radical cystectomy and transurethral electroresection in the treatment of muscle-invasive bladder cancer， and analyze the risk factors affecting the prognosis of the patients. Methods 69 cases with muscle-invasive bladder cancer diagnosed and treated in Department of Urologic Surgery of our hospital from January 2005 to October 2012 were selected and divided into the electroresection group（33 cases） and the radical group（36 cases）. Patients in the electroresection group were treated by transurethral electroresection of bladder tumor and postoperative intravenous and bladder perfusion chemotherapy， and those in the radical group were treated by radical cystectomy with postoperative intravenous chemotherapy. A 3-year follow-up was given to the patients. The duration of procedure， intraoperative blood loss， cumulative hospitalization time， 3-year recurrence-free survival （RFS）， and 3-year overall survival （OS） and so on were compared between the two groups. Potential risk factors were analyzed by univariate Log-rank and multivariate Cox regression. Results Compared with the radical group， the electroresection group had much shorter duration of procedure， much less intraoperative blood loss and obviously shorter length of stay（t=-22.020， -18.393， -7.205， P<0.01）. The difference in the recurrence rate and 3-year survival rate between the two groups was not statistically significant （χ2=0.338， 0.361， P>0.05）. Log-rank single factor analysis showed that， the prognosis of patients with the diameter of tumor ≥ 5 cm and T3 stage was poor； diameter of tumor ≥ 5 cm and T3 stage in patients were the risk factors of 3-year RFS and 3-year OS （χ2=8.183， 21.548， 8.427， 12.410， P<0.01）. Cox multivariate analysis showed that， the diameter of tumor ≥ 5 cm was the risk factor of 3-year RFS （RR=3.658， 95% CI： 1.875～7.137， P<0.01）； T3 stage and tumor diameter ≥ 5 cm were the risk factors related to 3-year OS （P<0.01）. Conclusion There is low risk of operation in transurethral electroresection of bladder tumor. Transurethral electroresection of bladder tumor combined with intravenous and bladder perfusion chemotherapy can achieve good therapeutic effect. The tumor diameter ≥5 cm and T3 stage are the important risk factors affecting the prognosis in patients with bladder cancer.

[Key words] Radical cystectomy； Transurethral electroresection； Bladder tumor； Prognosis

膀胱肿瘤是泌尿系肿瘤中最常见的肿瘤，占所有恶性肿瘤的20%左右。其中 90%以上为移行上皮癌[1]，多发生在三角区、两侧壁及颈部。其中肌层浸润性膀胱癌多已发生远处转移，复发率高，5 年生存率约25%[2-3]。该次研究通过回顾性分析2005年1月—2012年10月于该院泌尿外科诊治的69例肌层浸润性膀胱癌患者的临床资料，探讨经尿道电切术和根治性膀胱切除术治疗的疗效及预后影响因素，现报道如下。

1 资料与方法

1.1 一般资料

整群选取2005年1月—2012年10月于该院泌尿外科诊治的肌层浸润性膀胱癌患者69例，其中33例患者行尿道电切治疗（电切组），36例行根治性膀胱切除术（根治组），患者肿瘤临床分期为T2、T3期，盆腔淋巴结未见转移。……