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目的:评价经尿道膀胱肿瘤电切术(TURBT)治疗肌层浸润性膀胱癌(muscle invasive bladder cancer,MIBC)的临床疗效,探讨影响其预后的相关因素。方法:回顾性分析2007年1月~2013年1月于大连医科大学附属第二医院证实为MIBC且不愿接受或自身条件不能耐受根治性膀胱切除术而行TURBT辅以全身化疗或(和)膀胱灌注化疗的62例患者临床资料,采用Log-rank检验和Kaplan-Meier法进行其生存率分析并描绘生存曲线,以评估其疗效,同时建立Cox风险比例模型,分析影响MIBC患者预后的主要因素。结果:62例患者5年特异性生存率为62.9%,多因素分析显示:临床分期(OR=2.012,95%CI=1.281~3.188,P=0.002)、病理分级(OR=1.866,95%CI=1.158~3.012,P=0.020)、术后膀胱灌注化疗(OR=0.420,95%CI=0.186~0.951,P=0.042)进入Cox回归模型,影响患者预后,其中术后膀胱灌注化疗为保护性因素。结论:结合患者意愿及选择临床分期为T2、病理分级为低级别的MIBC患者,采用TURBT保留膀胱手术治疗可取得满意的临床疗效,可考虑作为除根治性膀胱切除术之外的另一种可选择的治疗肌层浸润性膀胱癌的手术方式。
Objective: To evaluate the clinical efficacy of transurethral resection of bladder tumor (TURBT) in the treatment of muscle invasive bladder cancer (MIBC) and to explore the related factors that affect its prognosis. Methods: A retrospective analysis was performed between January 2007 and January 2013 at the Second Affiliated Hospital of Dalian Medical University confirmed as MIBC and unwilling to accept or under its own condition can not tolerate radical cystectomy TURBT combined with systemic chemotherapy or ) Clinical data of 62 patients undergoing intravesical chemotherapy, Log-rank test and Kaplan-Meier survival rate analysis and survival curves to assess its efficacy, and to establish a Cox risk proportional model to analyze the prognosis of patients with MIBC main factor. Results: The 5-year specificity of 62 patients was 62.9%. Multivariate analysis showed that the clinical stage (OR = 2.012, 95% CI = 1.281-3.188, P = 0.002) (OR = 0.420, 95% CI = 0.186-0.951, P = 0.042) entered the Cox regression model, which affected the prognosis of the patients. The postoperative chemotherapy for bladder irrigation was protective factor. CONCLUSIONS: In combination with the patient’s wishes and the clinical stage of choice for T2, the pathological grade of MIBC patients with low-grade, the use of TURBT reserved bladder surgery can achieve satisfactory clinical efficacy can be considered as a radical cystectomy in addition to another The choice of surgical treatment of myometrial invasive bladder cancer.