Balbay M Derya, Cimentepe Ersin, Unsal Ali, Bayrak Omer, Koç Akif, Akbulut Ziya
Atatürk Training and Research Hospital, 1st Urology Clinic and Department of Urology, Fatih University School of Medicine, Ankara, Turkey.
J Urol. 2005 Dec;174(6):2260-2, discussion 2262-3. doi: 10.1097/01.ju.0000181811.61199.35.
In this prospective study we evaluated the incidence of bladder perforation after transurethral bladder tumor resection.
A total of 36 patients (33 male, 3 female, mean age +/- SD 65.6 +/- 11.43 [range 26 to 81]) with a solid mass in the bladder (mean 20.3 +/- 8.7 mm, range 5 to 40) were included in the study. Transurethral resections were performed with a 24Fr resectoscope. After the procedure an 18Fr Foley catheter was inserted into the bladder and 400 ml of 1/4 saline diluted contrast solution was instilled under gravity from 60 cm above the bladder. Complete filling and post-drainage radiographs were taken and examined for any evidence of extravasation. Regular evaluations with cystoscopy and ultrasound/computerized tomography were done to detect possible tumor recurrence and perivesical seeding.
Histopathological examination of the tumors showed transitional cell carcinoma in 35 patients and chronic eosinophilic cystitis in 1. Review of the cystograms revealed various degrees of extraperitoneal contrast extravasation around the resected area in 21 patients (58.3%). The only statistically significant difference between patients with and without extravasation was in tumor size (logistic stepwise regression p = 0.030,) among factors tested including patient age and localization, number of foci, tumor grade and stage. No apparent clinical problems requiring medical or surgical intervention other than urethral catheterization developed and no evidence of extravesical tumor seeding as per ultrasound and/or computerized tomography was seen during a mean followup of 21.9 months (range 7 to 40).
The extravasation of urine (asymptomatic perforation) after transurethral bladder tumor resection may occur much more frequently than believed or reported. It seems that this extravasation does not impose a significant risk of extravesical tumor seeding.
在这项前瞻性研究中，我们评估了经尿道膀胱肿瘤切除术后膀胱穿孔的发生率。
本研究共纳入36例膀胱内有实性肿块的患者（33例男性，3例女性，平均年龄±标准差65.6±11.43岁[范围26至81岁]），肿块平均大小为20.3±8.7mm（范围5至40mm）。使用24Fr电切镜进行经尿道切除术。术后将一根18Fr的Foley导尿管插入膀胱，并从膀胱上方60cm处重力滴注400ml 1/4生理盐水稀释的造影剂溶液。拍摄完全充盈和引流后的X线片，并检查有无外渗迹象。定期进行膀胱镜检查以及超声/计算机断层扫描评估，以检测可能的肿瘤复发和膀胱周围种植。
肿瘤的组织病理学检查显示，35例为移行细胞癌，1例为慢性嗜酸性膀胱炎。膀胱造影复查显示，21例患者（58.3%）在切除区域周围有不同程度的腹膜外造影剂外渗。在包括患者年龄、肿瘤位置、病灶数量、肿瘤分级和分期等测试因素中，有外渗和无外渗患者之间唯一具有统计学意义的差异在于肿瘤大小（逻辑逐步回归p = 0.030）。除了尿道插管外，未出现需要医疗或手术干预的明显临床问题，在平均21.9个月（范围7至40个月）的随访期间，超声和/或计算机断层扫描未发现膀胱外肿瘤种植的证据。
经尿道膀胱肿瘤切除术后尿液外渗（无症状穿孔）的发生频率可能比人们认为或报道的要高得多。这种外渗似乎不会带来膀胱外肿瘤种植的重大风险。
