目的: 探讨Ta 及T 1 期非肌层浸润性膀胱癌( Non－Muscle invasive bladder cancer NMIBC) 病人经尿
道膀胱肿瘤电切术( Transurethral resection of baldder tumor TUＲBT) 的安全切缘。方法: 回顾性分析120 例行
TUＲBT 的Ta 及T 1 期NMIBC 病人的病例资料，根据手术切缘范围分为10 mm 组( 38 例) 、15 mm 组( 52 例) 、20
mm 组( 30 例) ，分析3 组手术情况及术后复发情况，对肿瘤复发进行Cox 多因素分析。结果: 20 mm 组手术时间
长于10 mm 组、15 mm 组，术中出血量多于10 mm 组、15 mm 组，差异有统计学意义( P＜0．05) ; 20 mm 组术后出
血率为43．33%高于10 mm 组的15．79%、15 mm 组的17．31%，差异有统计学意义( P＜0．05) ，但10 mm 组、15 mm 组
术后出血率比较，差异无统计学意义( P＞0．05) ; 10 mm 组切缘阳性率44．74%高于15 mm 组的17．31%、20 mm 组
的13．33%，复发率为63．16%高于15 mm 组的38．46%、20 mm 组的36．67%，平均复发时间短于15 mm 组、20 mm
组，差异有统计学意义( P＜0．05) ，但15 mm 组、20 mm 组比较，差异无统计学意义( P＞0．05) 。单因素分析显示，
性别、肿瘤数量、临床分期与NMIBC 病人术后复发无关( P＞ 0．05) ，切缘范围、切缘阳性与术后复发有关( P＜
0．05) ; 采用Cox 回归分析显示，切缘范围减小、切缘阳性是NMIBC 复发的独立危险因素。结论: TUＲBT 切缘范
围为15 mm 既可减少手术时间、术中出血量，又不会增加降低切缘阳性率及术后复发率; 另外，切缘范围减小、切
缘阳性是NMIBC 术后复发的独立危险因素。

Objective: To investigate the safe margin of transurethral resection of bladder tumor
( TUＲBT) for patients with stage Ta and T1 non－muscle invasive bladder cancer( NMIBC) ．Methods:
The medical data of 120 patients with Ta and T1 NMIBC treated by TUＲBT were retrospectively analyzed．
According to the surgical margin scope， the patients were divided into 10 mm group( 38 cases) ，
15 mm group( 52 cases) and 20 mm group( 30 cases) ．The situation of surgery and recurrence after surgery
in 3 groups were analyzed，and tumor recurrence was analyzed by Cox multivariate analysis．Ｒesults:
The surgical time of 20 mm group was longer than that of 10 mm group or 15 mm group，and the
intraoperative blood loss was more than that of 10 mm group or 15 mm group( P＜0．05) ．The incidence
of bleeding in 20 mm group after surgery( 43．33%) was higher than that in 10 mm group( 15．79%) or
15 mm group( 17．31%) ( P＜0．05) ，but there was no significant difference in the incidence of bleeding
between 10 mm group and 15 mm group( P＞0．05) ．The positive rate of margin and recurrence rate in
10 mm group( 44．74%and 63．16%) were higher than those in 15 mm group( 17．31%and 38．46%) or
those in 20 mm group( 13．33%and 36．67%) ，and the average recurrence time was shorter than that of
15 mm group or 20 mm group( P＜0．05) ．However， there was no significant difference between 15 mm
group and 20 mm group( P＞0．05) ．Univariate analysis showed that gender，number of tumors and clinical
stage were not related to recurrence of patients with NMIBC after surgery( P＞0．05) ，while the margin
scope and positive rate of margin were related to recurrence after surgery( P＜0．05) ．Cox regression
analysis showed that decreased margin scope and positive margins were independent risk factors for recurrence
of NMIBC．Conclusion: 15 mm margin scope of TUＲBT not only can reduce the surgical time
and intraoperative blood loss but also can reduce the positive rate of margin and the recurrence rate after
surgery．Decreased margin scope and positive margin are independent risk factors of recurrence after
surgery for NMIBC．

Ｒ 737．14

 收稿日期: 2017－09－19; 修回日期: 2017－11－05
基金项目: 内蒙古自治区自然科学基金项目( 2016MS0855)
作者简介: 刘先艮( 1974－) ，男，南通大学附属南通第三人民医院副主任医师，医学硕士。
通讯作者: 侯俊秀，教授，主任医师，E－mail: houjunxiu1962@ 126．com 内蒙古医科大学附属医院内分泌科， 010050