| BackgroundThe radical cystectomy(RC)is the gold standard for muscle invasive bladder cancer(MIBC),but in clinical work,many MIBC patients,especially the elderly,are inclined to preserve the bladder because of poor physical condition,the high risk and high incidence of complications during perioperative,the decline in the quality of life and nursing inconvenience.Thus bladder-preserving strategies are more and more used in the treatment of MIBC.ObjectiveTo compare the clinical effects,advantages and disadvantages of transurethral resection of bladder tumor(TURBT),partial cystectomy(PC)and photoselective vaporization of bladder tumor(PVBT)in the treatment of bladder invasive bladder cancer in elderly patients,and evaluate their application value.Methods56 patients who were diagnosed as T2-T3N0-1M0 muscular invasive bladder cancer and administrated in Urology surgical of the First and Third Affiliated Hospital of Xinxiang Medical University during Jan 2010 to Jan 2013 were selected.All the patients were diagnosed by ultrasound,CT,MRI and confirmed by histopathologic examination of specimens.All patients were older than 60 years,the average age was 70.5±4.6 years old,and there were 43 cases of male patients and 13 cases of female patients,52 cases of stage T2,4 cases of stage T3,35 cases of patients with tumors less than 3cm in diameter,21 cases of patients with tumors more than 3cm in diameter,40 cases with solitary tumors and 16 cases of patients with multiple,19 cases of low grade,37 cases of high grade.All patients were divided into three groups,including 26 cases of TURBT group,17 cases in PVBTgroup and 13 cases in PC group.A retrospective comparison is conducted to analysis the operation time,intraoperative blood loss,hospital stay,one to five years survival rates and the quality of life scores of the three groups before and one month after operation.Results1.There is no significant difference between the three groups for subjects of age,gender,body mass index(BMI),TNM stage,tumor size and tumor grade(P> 0.05).2.The average operative time in group TURBT was(60.19±11.87)min,the average time of operation in group PVBT was(48.53±8.80)min,and the operative time in group PC was(192.69±21.47)min,the time of operation in PC group was longer than that in TURBT group and PVBT group,the difference was statistically significant(P<0.05).The average blood loss was(27.50±6.96)ml in TURBT group,(17.35±7.93)ml in group PVBT and(165.77±15.39)ml in group PC.The blood loss in group PC was higher than that in TURBT group and PVBT group,and the difference was statistically significant(P<0.05).The average time of indwelling catheter in group PC was(11.77±1.16)d,which was significantly higher than that(3.08±1.02)d in TURBT group and(1.76 ±0.66)d in PVBT group,the difference was statistically significant(P<0.05).3.The average hospitalization time of patients in group PC were(13.69 + 1.44)d,longer than that(7.08±1.38)d in TURBT group and(4.82±0.73)d in PVBT group,the differences were statistically significant(P<0.05).The average hospitalization cost of PVBT group were(17547.94±1123.61)yuan,higher than that of TURBT group(11322.05±1001.52)yuan and PC group(10838.59±645.22)yuan,the difference was statistically significant(P<0.05).4.The survival rates after 1-5 years were 92.31%,84.61%,69.23%,53.85%,46.15% in TURBT group and 94.12%,82.35%,64.70%,58.82%,47.06% in PVBT group and84.61%,76.92%,69.23%,61.53%,53.85% in PC group,the difference was statistically significant(P<0.05).5.Results of the Log-rank univariate analysis showed that T3 stage(P<0.05),andtumor size>3cm(P<0.05)were the important factors of 5 years survival rate.6.One month after operation,the quality of life(SF-36)score of the three groups patients was improved in both body health and mental health,and the difference was statistically significant(P<0.05).Conclusion1.For the reasonable selection of patients with MIBC,TURBT,PVBT,and PC are feasible,the survival rate are similar to that of RC,with fewer trauma and complications,especially for elderly patients with bladder preservation willingness or poor general condition.2.There was no significant difference in 1-5 year survival rate between the three operative methods.TURBT and PVBT had the advantages of shorter operation time and catheter indwelling time,less bleeding,and shorter hospitalization time,but the cost of PVBT was higher than that of TURBT and PC.3.Having tumors larger than 3cm and tumors of T3 stage are important factors affecting the postoperative survival rate.4.Of all the patients,the SF-36 scores increased in physical health,mental health and total score in one month after operation,suggesting that the above three ways of operative methods can improve the life quality of patients. |
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