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经尿道膀胱肿瘤切除术(TURBT)

[Transurethral resection of bladder tumors (TURBT)].

作者信息

Oswald D, Pallauf M, Herrmann T R W, Netsch C, Becker B, Lehrich K, Miernik A, Schöb D S, Sievert K D, Gross A J, Westphal J, Lusuardi L, Deininger S

机构信息

Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Universitätsklinik für Urologie und Andrologie der PMU, Salzburger Landeskliniken, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.

Urologie, Kantonsspital Frauenfeld, Frauenfeld, Schweiz.

出版信息

Urologe A. 2022 Jan;61(1):71-82. doi: 10.1007/s00120-021-01741-z. Epub 2022 Jan 4.

Abstract

Transurethral resection of bladder tumors (TURBT) is the standard of care for the diagnostics and primary treatment of bladder tumors. These are removed by fragmentation using loop diathermy. The resection area is coagulated for hemostasis. An important aspect is always a complete resection with an adequate amount of detrusor muscle in the specimen. Postoperative intravesical instillation of single-shot chemotherapy has been proven to reduce recurrence rates. Methods for improved tumor visualization (particularly photodynamic diagnostics) are used to enhance tumor detection rates particularly in multifocal tumors or carcinoma in situ (CIS). Thus, recurrence and progression rates can be reduced. Depending on the histological examination of the TURBT specimen, follow-up treatment for non-muscle invasive bladder tumors are adjuvant instillation treatment using chemotherapy or Bacillus Calmette-Guérin (BCG), second look TURBT and early cystectomy or for muscle invasive bladder tumors, radical cystectomy or (oncologically subordinate) trimodal treatment with renewed TURBT, radiotherapy and chemotherapy are indicated. Possible complications of TURBT include bleeding with bladder tamponade, extraperitoneal or intraperitoneal bladder perforation and infections of the urogenital tract.

摘要

经尿道膀胱肿瘤切除术(TURBT)是膀胱肿瘤诊断和初始治疗的标准方法。使用环状电刀将肿瘤碎解切除,对切除区域进行凝血止血。一个重要方面始终是标本中完整切除足够量的逼尿肌。术后单次膀胱内灌注化疗已被证明可降低复发率。用于改善肿瘤可视化的方法(特别是光动力诊断)用于提高肿瘤检出率,尤其是在多灶性肿瘤或原位癌(CIS)中。因此,可以降低复发和进展率。根据TURBT标本的组织学检查结果,非肌层浸润性膀胱肿瘤的后续治疗为使用化疗或卡介苗(BCG)进行辅助灌注治疗、二次经尿道膀胱肿瘤切除术以及早期膀胱切除术;对于肌层浸润性膀胱肿瘤,则需进行根治性膀胱切除术或(肿瘤学上次要的)三联治疗,包括再次经尿道膀胱肿瘤切除术、放疗和化疗。经尿道膀胱肿瘤切除术可能的并发症包括膀胱填塞出血、膀胱腹膜外或腹膜内穿孔以及泌尿生殖道感染。

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