Otto W, Fritsche H-M, Dirmeyer M, Burger M, Straub M, Rössler W, Wieland W F, Denzinger S
Caritas-Krankenhaus St. Josef, Klinik und Poliklinik für Urologie der Universität Regensburg.
Aktuelle Urol. 2010 Sep;41(5):316-9. doi: 10.1055/s-0030-1247481. Epub 2010 Jul 28.
Transurethral resection of the bladder (TURB) is one of the most common surgical treatments in urology. We examined the TURBs that had been carried out during one year for suspected bladder cancer (first findings and recurrence) and then analysed the further clinical courses of these patients within the first twelve months after TURB.
We recorded retrospectively the course of 160 patients in whom altogether 210 elective TURBs had been performed in our clinic between April 2007 and March 2008 (observation period). In addition, the patients' further clinical course within the first twelve months after TURB was recorded (follow-up period). All initial and recurrence TURB were carried out with photodynamic diagnosis; the histological evaluation was performed at a university centre.
71 % of the 118 initial resections performed during the observation period showed urothelial cell carcinoma of the bladder - pTa (61 %), pT1 (20 %), pT2-4 (17 %), Cis (2 %) while 60 re-TURBs in the whole period detected 17 % residual tumours. According to the guidelines, 18 patients (14 %) received instillation therapy with mitomycin C, 32 patients (25 %) with Bacillus Calmette-Guérin (BCG). Cystectomies were performed on 23 patients (18 %). 18 TURBs after suspected recurrence in the follow-up period confirmed recurrence in 28 %, which represents a recurrence rate of 4 %. In the same period 5 patients (4 %) developed distant metastases, two patients (2 %) died. Two patients (7 %) with initially benign findings developed bladder cancer in the follow-up period.
We present an analysis of TURBs performed at a university centre. When bladder cancer is diagnosed in 7 % within one year after urocystitis has been detected in the initial TURB findings, regular follow-up examination of these patients, especially with certain risk profiles, has to be discussed.
经尿道膀胱肿瘤切除术(TURB)是泌尿外科最常见的手术治疗方法之一。我们检查了一年内因疑似膀胱癌(初发和复发)而进行的TURB手术,然后分析了这些患者在TURB术后头十二个月内的进一步临床病程。
我们回顾性记录了2007年4月至2008年3月(观察期)在我们诊所共进行210例择期TURB手术的160例患者的病程。此外,还记录了患者在TURB术后头十二个月内的进一步临床病程(随访期)。所有初发和复发的TURB手术均采用光动力诊断;组织学评估在大学中心进行。
观察期内进行的118例初发切除术中有71%显示为膀胱尿路上皮癌——pTa期(61%)、pT1期(20%)、pT2 - 4期(17%)、Cis期(2%),而整个期间的60例再次TURB手术检测到17%的残留肿瘤。根据指南,18例患者(14%)接受了丝裂霉素C灌注治疗,32例患者(25%)接受了卡介苗(BCG)灌注治疗。23例患者(18%)进行了膀胱切除术。随访期内疑似复发后进行的18例TURB手术证实28%复发,表示复发率为4%。同期5例患者(占4%)发生远处转移,2例患者(占2%)死亡。2例最初检查结果为良性的患者在随访期内患膀胱癌。
我们展示了在大学中心进行的TURB手术分析。当初发TURB检查发现膀胱炎后一年内膀胱癌诊断率为7%时,必须讨论对这些患者,尤其是具有某些风险特征的患者进行定期随访检查。