经尿道膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌的疗效分析
|
摘要
目的探讨经尿道膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌的疗效。方法采用随机数字表法将98例非肌层浸润性膀胱癌患者分为观察组和对照组,每组49例,观察组患者接受经尿道膀胱肿瘤整块切除术,对照组患者接受经尿道膀胱肿瘤电切术(TURBT)。比较两组患者的围手术期相关指标(手术时间、住院时间、术中出血量、留置导尿管时间、膀胱冲洗时间),术前及术后3个月的血清血管内皮生长因子(VEGF)、重组人Dickkopf相关蛋白1(DKK1)、人类软骨糖蛋白-39(YKL40)水平及手术相关并发症的发生率。结果观察组患者的手术时间、住院时间、留置导尿管时间、膀胱冲洗时间均明显短于对照组,术中出血量明显少于对照组,差异均有统计学意义(P﹤0.01)。术前,两组患者的血清VEGF、DKK1、YKL40水平比较,差异均无统计学意义(P﹥0.05)。术后3个月,两组患者的血清VEGF、DKK1、YKL40水平均较本组术前降低(P﹤0.05);术后3个月,两组患者的血清VEGF、DKK1、YKL40水平比较,差异均无统计学意义(P﹥0.05)。观察组患者的并发症总发生率为4.08%,低于对照组的16.33%,差异有统计学意义(P﹤0.05)。结论经尿道膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌的效果与TURBT相当,但创伤更小、术后恢复更快、并发症更少。
Objective To evaluate the efficacy of en-bloc transurethral resection of bladder tumor(TURBT) for nonmuscle invasive bladder cancer(NMIBC). Method A total of 98 patients with NMIBC were divided into observation group and control group with 49 cases in each group by using a random number table. En-bloc TURBT was performed on patients in observation group and TURBT was performed on patients in control group. The perioperative indicators including the operation time, hospitalization time, intraoperative blood loss, indwelling catheter time, bladder irrigation time were compared between the two groups. The levels of serum metrics including vascular endothelial growth factor(VEGF), recombinant human Dickkopf-related protein 1(DKK1) and human cartilage glycoprotein-39(HCgp-39/YKL40) before surgery and 3 months after surgery, and the incidence of surgery related complications were compared between the two groups. Result The operation time, hospitalization time, indwelling catheter time and bladder irrigation time were shorter, and intraoperative bleeding loss was less in observation group than those of the control group, the differences were statistically significant(P<0.01). Before operation, the levels of serum VEGF, DKK1 and YKL40 of patients in the two groups shows no significant difference(P>0.05). At 3 months after operation, the serum VEGF, DKK1 and YKL40 levels in both groups were significant lower than those before operation(P<0.05), while the VEGF, DKK1 and YKL40 levels between the two groups showed no significant difference(P>0.05). The complication rate in the observation group was 4.08%, which was significantly lower than that of 16.33% in the control group(P<0.05). Conclusion En-bloc TURBT is as effective as TURBT in terms of the treatment of NMIBC, and this method of surgery is associated with less trauma, faster recovery time and fewer complications.
Objective To evaluate the efficacy of en-bloc transurethral resection of bladder tumor(TURBT) for nonmuscle invasive bladder cancer(NMIBC). Method A total of 98 patients with NMIBC were divided into observation group and control group with 49 cases in each group by using a random number table. En-bloc TURBT was performed on patients in observation group and TURBT was performed on patients in control group. The perioperative indicators including the operation time, hospitalization time, intraoperative blood loss, indwelling catheter time, bladder irrigation time were compared between the two groups. The levels of serum metrics including vascular endothelial growth factor(VEGF), recombinant human Dickkopf-related protein 1(DKK1) and human cartilage glycoprotein-39(HCgp-39/YKL40) before surgery and 3 months after surgery, and the incidence of surgery related complications were compared between the two groups. Result The operation time, hospitalization time, indwelling catheter time and bladder irrigation time were shorter, and intraoperative bleeding loss was less in observation group than those of the control group, the differences were statistically significant(P<0.01). Before operation, the levels of serum VEGF, DKK1 and YKL40 of patients in the two groups shows no significant difference(P>0.05). At 3 months after operation, the serum VEGF, DKK1 and YKL40 levels in both groups were significant lower than those before operation(P<0.05), while the VEGF, DKK1 and YKL40 levels between the two groups showed no significant difference(P>0.05). The complication rate in the observation group was 4.08%, which was significantly lower than that of 16.33% in the control group(P<0.05). Conclusion En-bloc TURBT is as effective as TURBT in terms of the treatment of NMIBC, and this method of surgery is associated with less trauma, faster recovery time and fewer complications.
引文
[1]钟惟德.膀胱癌流行病学[M].北京:人民卫生出版社,2012.
[2]闫伟,乔庐东,杜震,等.经尿道双极等离子针状电极肿瘤整块切除术治疗非肌层浸润性膀胱尿路上皮癌的临床分析[J].中华泌尿外科杂志,2016,37(9):672-676.
[3]陈思阳,丰琅,杜源,等.经尿道针状电极膀胱肿瘤整块切除术与经尿道钬激光膀胱肿瘤切除术治疗非肌层浸润性膀胱癌的治疗效果和安全性比较[J].首都医科大学学报,2018,39(3):439-443.
[4]杨玉帛,刘振华,韩平.经尿道膀胱肿瘤整块切除术的研究进展[J].临床泌尿外科杂志,2017,22(10):775-778.
[5]符伟军.膀胱癌患者诊疗指南[M].北京:人民军医出版社,2014.
[6]平秦榕,王剑松,颜汝平,等.高危非肌层浸润性膀胱癌的治疗进展[J].山东医药,2017,57(31):104-107.
[7]Zhao C,Tang K,Yang H,et al.Bipolar versus monopolar transurethral resection of nonmuscle-invasive bladder cancer:a meta-analysis[J].J Endourol,2016,30(1):5-12.
[8]楚广民,张建波,孙淼淼.SOX9基因沉默对膀胱癌EJ细胞株生物学特性的影响及其机制研究[J].癌症进展,2018,16(3):286-289.
[9]Suer E,Hamidi N,Gokce MI,et al.Significance of second transurethral resection on patient outcomes in muscle-invasive bladder cancer patients treated with bladder-preserving multimodal therapy[J].World J Urol,2016,34(6):847-851.
[10]邱柏圣,杜君,张艳辉,等.免疫组织化学指标判断非肌层浸润性膀胱癌分期及病理分级的价值[J].中国肿瘤临床,2018,18(1):37-41.
[11]夏中友,伍季,张萌,等.前列腺癌组织中ING4与VEGF的表达及相关性研究[J].西部医学,2017,29(2):187-191.
[12]孙斌.血清TGF-β1、VEGF及IL-6水平与前列腺癌骨转移相关性分析[J].临床和实验医学杂志,2018,17(19):74-77.
[13]贺松其,程旸,朱云,等.鳖甲煎丸对肝细胞癌中Wnt/β-catenin信号通路及抑制基因DKK1、FrpHe表达的影响[J].南方医科大学学报,2013,33(1):30-33.
[14]陆衡,刘延国,李曙光,等.YKL40对卵巢癌SKOV-3细胞迁移能力的影响[J].山东大学学报(医学版),2017,55(1):33-38.
[15]程浩,许军.YKL40与乳腺癌预后的研究进展[J].中国现代普通外科进展,2016,19(1):39-41.
[2]闫伟,乔庐东,杜震,等.经尿道双极等离子针状电极肿瘤整块切除术治疗非肌层浸润性膀胱尿路上皮癌的临床分析[J].中华泌尿外科杂志,2016,37(9):672-676.
[3]陈思阳,丰琅,杜源,等.经尿道针状电极膀胱肿瘤整块切除术与经尿道钬激光膀胱肿瘤切除术治疗非肌层浸润性膀胱癌的治疗效果和安全性比较[J].首都医科大学学报,2018,39(3):439-443.
[4]杨玉帛,刘振华,韩平.经尿道膀胱肿瘤整块切除术的研究进展[J].临床泌尿外科杂志,2017,22(10):775-778.
[5]符伟军.膀胱癌患者诊疗指南[M].北京:人民军医出版社,2014.
[6]平秦榕,王剑松,颜汝平,等.高危非肌层浸润性膀胱癌的治疗进展[J].山东医药,2017,57(31):104-107.
[7]Zhao C,Tang K,Yang H,et al.Bipolar versus monopolar transurethral resection of nonmuscle-invasive bladder cancer:a meta-analysis[J].J Endourol,2016,30(1):5-12.
[8]楚广民,张建波,孙淼淼.SOX9基因沉默对膀胱癌EJ细胞株生物学特性的影响及其机制研究[J].癌症进展,2018,16(3):286-289.
[9]Suer E,Hamidi N,Gokce MI,et al.Significance of second transurethral resection on patient outcomes in muscle-invasive bladder cancer patients treated with bladder-preserving multimodal therapy[J].World J Urol,2016,34(6):847-851.
[10]邱柏圣,杜君,张艳辉,等.免疫组织化学指标判断非肌层浸润性膀胱癌分期及病理分级的价值[J].中国肿瘤临床,2018,18(1):37-41.
[11]夏中友,伍季,张萌,等.前列腺癌组织中ING4与VEGF的表达及相关性研究[J].西部医学,2017,29(2):187-191.
[12]孙斌.血清TGF-β1、VEGF及IL-6水平与前列腺癌骨转移相关性分析[J].临床和实验医学杂志,2018,17(19):74-77.
[13]贺松其,程旸,朱云,等.鳖甲煎丸对肝细胞癌中Wnt/β-catenin信号通路及抑制基因DKK1、FrpHe表达的影响[J].南方医科大学学报,2013,33(1):30-33.
[14]陆衡,刘延国,李曙光,等.YKL40对卵巢癌SKOV-3细胞迁移能力的影响[J].山东大学学报(医学版),2017,55(1):33-38.
[15]程浩,许军.YKL40与乳腺癌预后的研究进展[J].中国现代普通外科进展,2016,19(1):39-41.