北京大学学报(医学版) ›› 2020, Vol. 52 ›› Issue (4): 697-700. doi: 10.19723/j.issn.1671-167X.2020.04.019

• 论著 • 上一篇    下一篇

窄带成像与白光在经尿道膀胱肿瘤切除术中的自身对照分析

邱敏,徐楚潇,王滨帅,颜野,邓绍晖,肖春雷,刘承,卢剑,田晓军(),马潞林   

  1. 北京大学第三医院泌尿外科,北京 100191
  • 收稿日期:2020-02-28 出版日期:2020-08-18 发布日期:2020-08-06
  • 通讯作者: 田晓军 E-mail:txjtt@sina.com

Analysis of self-control trial results of narrow band imaging and white light in transurethral resection of bladder tumor

Min QIU,Chu-xiao XU,Bin-shuai WANG,Ye YAN,Shao-hui DENG,Chun-lei XIAO,Cheng LIU,Jian LU,Xiao-jun TIAN(),Lu-lin MA   

  1. Department of Urology,Peking University Third Hospital,Beijing 100191, China
  • Received:2020-02-28 Online:2020-08-18 Published:2020-08-06
  • Contact: Xiao-jun TIAN E-mail:txjtt@sina.com

摘要:

目的: 探讨窄带成像(narrow band imaging,NBI)辅助白光经尿道膀胱肿瘤切除术(transurethral resection of bladder tumor,TURBT)治疗膀胱尿路上皮癌的效果,总结NBI手术经验。方法: 选择2018年4月至2020年1月北京大学第三医院泌尿外科就诊膀胱尿路上皮癌的患者,麻醉后行TURBT。术中先在白光下寻找膀胱肿瘤并切除,完整取出病理标本。换成NBI,寻找可疑病灶并切除,将病理标本完整取出。两组术后标本区分开分别送病理科,记录白光下病灶的数目、位置及病理诊断结果,同时记录NBI下白光残留病灶的情况。计算白光下电切后膀胱肿瘤残留的比例,评估NBI的效果。后期病例按时间顺序平均分为3组,统计各组的临床数据,观察NBI辅助白光下TURBT的学习曲线。结果: 参加研究的患者共45例,其中男32例,女13例,年龄23~89岁,平均65.2岁。45例手术均顺利完成,术后未见明显并发症及发生。术中发现9例为单发,36例为多发,肿瘤最大径0.5~4.0 cm,平均2.2 cm。白光下切除标本病理诊断均为尿路上皮癌,另有19例白光切除后NBI辅助下再次切除标本病理诊断阳性(42.2%)。按时间顺序将45例分为3组,每组15例,白光下切除后3组NBI的真阳性率分别为33.3%、46.7%、46.7%,假阳性率分别为60.0%、46.7%、26.7%。结论: TURBT是治疗膀胱尿路上皮癌的有效方式,NBI是白光的有效补充,能增加膀胱肿瘤的检出率,减少术后复发。NBI光源有一定的学习曲线,随着病例的增加,NBI下假阳性率逐渐降低,而术者NBI经验丰富后,在白光下对扁平样肿瘤的辨识度也逐渐提高,白光下肿瘤切除后NBI辅助治疗肿瘤残留率降低。

关键词: 窄带成像, 膀胱肿瘤, 经尿道膀胱肿瘤切除术

Abstract:

Objective: To investigate the effect of NBI assisted white light transurethral resection of bladder tumor (TURBT) in the treatment of bladder urothelial carcinoma and to summarize the experience of narrow band imaging (NBI) operation. Methods: Patients with bladder urothelial carcinoma were selected, and TURBT was performed after anesthesia. First of all, the bladder tumor was found and resected under white light. Then we replaced with NBI, looked for suspicious lesions and resected them, The specimens excised under white light and NBI were collected separately. The number, location and pathological results of the lesions under white light were recorded, and the residual lesions under NBI were also recorded. To evaluate the effect of NBI, the ratio of residual bladder tumor was calculated. The cases were divided into three groups according to the time sequence. The clinical data of each group were collected and the learning curve of TURBT under NBI assisted white light was observed. Results: A prospective study of 45 patients with bladder tumor from April 2018 to January 2020, including 32 males and 13 females, aged from 23 to 89 years, with an average age of 65.2 years. All the operations were successfully completed, without obvious complications after operation. Nine cases were single and 36 cases were multiple. The maximum diameter of the tumors was 0.5 to 4.0 cm, with an average of 2.2 cm. The histopathology of the resected tissue under white light was urothelial carcinoma, and 19 cases (42.2%) were pathologically positive by NBI resection. The 45 cases were divided into three groups according to the time sequence, 15 cases in each group. The true positive rate of NBI was 33.3%, 46.7% and 46.7%, respectively, and the false positive rate was 60.0%, 46.7% and 26.7%, respectively in the three groups. Conclusion: TURBT is an effective way to treat bladder urothelial cancer, NBI is an effective supplement of white light, which can increase the detection rate of bladder cancer and reduce post-operative recurrence. The NBI light source has a certain learning curve. With the increase of cases, the false-positive rate of NBI is gradually reduced. After the NBI operator has rich experience, the recognition degree of flat tumor is gradually improved under white light, and the residual rate of NBI is reduced after the removal under white light.

Key words: Narrow band imaging, Bladder tumor, Transurethral resection of bladder tumor

中图分类号: 

  • R737.14

图1

白光下乳头状肿瘤"

图2

NBI下肿瘤微小肿瘤,与周围对比明显(箭头)"

表1

不同组白光切除后NBI的临床数据"

Group Number of NBI
suspected cases
Number of no
residues by NBI
Number of pathological
positive by NBI resection
(True positive rate)
Number of pathological
negative by NBI resection
(False positive rate)
The first 15 cases 14 (93.3) 1 (6.7) 5 (33.3) 9 (60)
The second 15 cases 14 (93.3) 1 (6.7) 7 (46.7) 7 (46.7)
The last 15 cases 11 (73.3) 4 (26.7) 7 (46.7) 4 (26.7)
Total 45 cases 39 (86.7) 6 (13.3) 19 (42.2) 20 (44.4)
[1] Li K, Lin T, Xue W, et al. Current status of diagnosis and treatment of bladder cancer in China: analyses of Chinese bladder cancer consortium database[J]. Asian J Urol, 2015,2(2):63-69.
[2] Naselli A, Introini C, Timossi L, et al. A randomized prospective trial to assess the impact of transurethral resection in narrow band imaging modality on non-muscle-invasive bladder cancer recurrence[J]. Eur Urol, 2012,61(5):908-913.
pmid: 22280855
[3] 廖洪, 李汉忠, 张玉石, 等. 单中心尿路上皮癌2 115例临床特点分析[J]. 中华泌尿外科杂志, 2014,35(12):900-904.
[4] Bryan RT, Billingham LJ, Wallace DM. Narrow-band imaging flexible cystoscopy in the detection of recurrent urothelial cancer of the bladder[J]. BJU Int, 2008,101(6):702-705.
[5] Cauberg ECC, Mamoulakis C, de la Rosette JJMC, et al. Narrow band imaging-assisted transurethral resection for non-muscle invasive bladder cancer significantly reduces residual tumour rate[J]. World J Urol, 2011,29(4):503-509.
pmid: 21350871
[6] Malik K, Raja A, Mahalingam S, et al. Usefulness of narrow-band imaging in transurethral resection of bladder tumor: early experience from a tertiary center in India[J]. South Asian J Cancer, 2019,8(4):226.
pmid: 31807483
[7] 邱敏, 颜野, 田晓军, 等. 窄带成像技术辅助经尿道膀胱肿瘤切除术[J]. 中国微创外科杂志, 2018,18(10):888-890.
[8] Naito S, Algaba F, Babjuk M, et al. The clinical research office of the endourological society (CROES) multicentre randomised trial of narrow band imaging-assisted transurethral resection of bladder tumour (TURBT) versus conventional white light imaging-assisted TURBT in primary non-muscle-invasive bladder cancer patients: trial protocol and 1-year results[J]. Eur Urol, 2016,70(3):506-515.
pmid: 27117749
[9] Shadpour P, Emami M, Haghdani S. A Comparison of the progression and recurrence risk index in non-muscle-invasive bladder tumors detected by narrow-band imaging versus white light cystoscopy, based on the EORTC scoring system[J]. Nephro-Urol Mon, 2016,8(1):e33240.
[10] 唐兴国, 颜野, 邱敏, 等. 单中心16年青年膀胱尿路上皮癌患者的诊治[J]. 北京大学学报(医学版), 2018,50(4):630-633.
[11] Dalgaard LP, Zare R, Gaya JM, et al. Prospective evaluation of the performances of narrow-band imaging flexible videoscopy relative to white-light imaging flexible videoscopy, in patients scheduled for transurethral resection of a primary NMIBC[J]. World J Urol, 2018,37(8):1615-1621.
[1] 赵世明,杨铁军,许春苗,郭孝峰,马永康,陈学军,李祥,何朝宏. 3.0T磁共振成像在接受过经尿道膀胱肿瘤切除术膀胱癌中诊断肌层浸润的应用[J]. 北京大学学报(医学版), 2020, 52(4): 701-704.
[2] 王田,洪欣,王晓峰. 等离子针状电极在经尿道近输尿管口膀胱肿瘤切除术中的临床应用(附16例报道)[J]. 北京大学学报(医学版), 2020, 52(4): 632-636.
[3] 黄厚锋,张玉石,范欣荣,严维刚,纪志刚,李汉忠. 膀胱平滑肌瘤临床特点分析[J]. 北京大学学报(医学版), 2019, 51(2): 372-373.
[4] 王焕瑞,张维宇,刘献辉,胡浩,张晓鹏,许克新. 大部分膀胱切除生物补片膀胱扩大术在高龄浸润性膀胱癌患者中的应用[J]. 北京大学学报(医学版), 2018, 50(4): 626-629.
[5] 周建华,王地,王焕瑞,侯晓利,郁卫东,许克新,胡浩. γδT细胞对膀胱癌细胞的细胞毒活性及MICA/B蛋白在膀胱癌中的表达[J]. 北京大学学报(医学版), 2018, 50(4): 595-601.
[6] 林天歆. 膀胱癌的淋巴结清扫范围[J]. 北京大学学报(医学版), 2017, 49(4): 565-568.
[7] 郝瀚,苏晓鸿,郑卫,葛鹏,何群,沈棋,杨新宇,张争,李学松,林健,周利群. 非肌层浸润性膀胱癌行膀胱根治性切除[J]. 北京大学学报(医学版), 2016, 48(4): 627-631.
[8] 刘余庆, 卢剑, 赵磊, 侯小飞, 马潞林. 肾移植受者上尿路尿路上皮癌术后膀胱复发的预后因素[J]. 北京大学学报(医学版), 2015, 47(4): 605-610.
[9] 郝瀚, 吴鑫, 郑卫, 虞巍, 范宇, 何群, 李学松, 周利群. 膀胱尿路上皮癌淋巴结转移特点:单中心522例膀胱根治性切除病例回顾[J]. 北京大学学报(医学版), 2014, 46(4): 524-527.
[10] 张治草,黄毅,王秀杰,王猛,马潞林. 膀胱尿路上皮癌患者血液中微小RNA的表达[J]. 北京大学学报(医学版), 2013, 45(4): 532-.
[11] 沈棋,孙莉华,王静华,刘漓波,何群,金杰. 32例肾源性腺瘤临床病理特点及免疫组织化学染色分析[J]. 北京大学学报(医学版), 2013, 45(4): 522-.
[12] 杨轩, 袁栋栋, 姜学军, 席志军. 顺铂通过诱导膀胱癌细胞自噬促进细胞凋亡[J]. 北京大学学报(医学版), 2013, 45(2): 221-.
[13] 郑卫, 吴鑫, 张雷, 宋刚, 张争, 龚侃, 宋毅, 李学松, 何志嵩, 周利群. 腹腔镜膀胱全切手术:单中心60例学习曲线结果分析[J]. 北京大学学报(医学版), 2012, 44(4): 558-562.
[14] 罗道升, 米其武, 孟祥军, 高勇, 戴宇平, 邓春华. 外磁场协同卟啉-葡聚糖磁性纳米微粒的光动力学对人膀胱癌细胞的杀伤作用[J]. 北京大学学报(医学版), 2012, 44(4): 524-537.
[15] 温英武, *, 申克辉, *, 虞巍, 郭应禄, 何群, 席志军. 208例根治性膀胱切除术术后并发症的危险因素分析[J]. 北京大学学报(医学版), 2011, 43(4): 565-569.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 田增民, 陈涛, Nanbert ZHONG, 李志超, 尹丰, 刘爽. 神经干细胞移植治疗遗传性小脑萎缩的临床研究(英文稿)[J]. 北京大学学报(医学版), 2009, 41(4): 456 -458 .
[2] 郭岩, 谢铮. 用一代人时间弥合差距——健康社会决定因素理论及其国际经验[J]. 北京大学学报(医学版), 2009, 41(2): 125 -128 .
[3] 成刚, 钱振华, 胡军. 艾滋病项目自愿咨询检测的技术效率分析[J]. 北京大学学报(医学版), 2009, 41(2): 135 -140 .
[4] 卢恬, 朱晓辉, 柳世庆, 郑杰, 邱晓彦. 白细胞介素2促进宫颈癌细胞系HeLaS3免疫球蛋白G的表达[J]. 北京大学学报(医学版), 2009, 41(2): 158 -161 .
[5] 袁惠燕, 张苑, 范田园. 离子交换型栓塞微球及其载平阳霉素的制备与性质研究[J]. 北京大学学报(医学版), 2009, 41(2): 217 -220 .
[6] 徐莉, 孟焕新, 张立, 陈智滨, 冯向辉, 释栋. 侵袭性牙周炎患者血清中抗牙龈卟啉单胞菌的IgG抗体水平的研究[J]. 北京大学学报(医学版), 2009, 41(1): 52 -55 .
[7] 祁琨, 邓芙蓉, 郭新彪. 纳米二氧化钛颗粒对人肺成纤维细胞缝隙连接通讯的影响[J]. 北京大学学报(医学版), 2009, 41(3): 297 -301 .
[8] 李宏亮*, 安卫红*, 赵扬玉, 朱曦. 妊娠合并高脂血症性胰腺炎行血液净化治疗1例[J]. 北京大学学报(医学版), 2009, 41(5): 599 -601 .
[9] 李伟军, 邢晓芳, 曲立科, 孟麟, 寿成超. PRL-3基因C104S位点突变体和CAAX缺失体的构建及表达[J]. 北京大学学报(医学版), 2009, 41(5): 516 -520 .
[10] 丰雷, 王玉凤, 曹庆久. 哌甲酯对注意缺陷多动障碍儿童平衡功能影响的开放性研究[J]. 北京大学学报(医学版), 2007, 39(3): 304 -309 .