• 1. 四川大學(xué)華西醫(yī)院泌尿外科,成都6100412. 武警總醫(yī)院泌尿外科,北京1000393. 四川大學(xué)華西醫(yī)院病理科;

目的 　評(píng)價(jià)尿脫落細(xì)胞嗜銀染色結(jié)合B超聯(lián)合診斷膀胱移行細(xì)胞癌經(jīng)尿道手術(shù)后復(fù)發(fā)的敏感性和特異性.
方法 　采用盲法對(duì)每一納入研究對(duì)象同時(shí)進(jìn)行尿脫落細(xì)胞嗜銀染色、經(jīng)直腸B超和膀胱鏡檢查,以膀胱鏡結(jié)合病理檢查的結(jié)果為金標(biāo)準(zhǔn),計(jì)算尿脫落細(xì)胞嗜銀染色結(jié)合B超聯(lián)合診斷膀胱癌經(jīng)尿道手術(shù)后復(fù)發(fā)的敏感性、特異性和ROC曲線下面積.當(dāng)尿脫落細(xì)胞嗜銀染色或/和B超陽(yáng)性時(shí),聯(lián)合診斷試驗(yàn)的結(jié)果為陽(yáng)性;當(dāng)尿脫落細(xì)胞嗜銀染色和B超均陰性時(shí),聯(lián)合診斷試驗(yàn)的結(jié)果為陰性.
結(jié)果 　納入148例膀胱移行細(xì)胞癌經(jīng)尿道手術(shù)后1年以上的門診隨訪病例,其中57例復(fù)發(fā),復(fù)發(fā)率為38.51%.單用尿脫落細(xì)胞嗜銀染色診斷復(fù)發(fā)的敏感性和特異性是89.47% [95%CI(0.82,0.98)]和87.91% [95%CI(0.81,0.95)],ROC曲線下面積為82.22%.單用B超診斷復(fù)發(fā)的敏感性和特異性是57.90% [95%CI(0.45,0.71)] 和90.11% [95%CI (0.84,0.96)],ROC曲線下面積73.13%.當(dāng)結(jié)合尿脫落細(xì)胞嗜銀染色和B超聯(lián)合診斷時(shí),敏感性提高至94.74% [95%CI (0.89,1.00)],而特異性有所下降,為84.62% [95%CI (0.77,0.92)],ROC曲線下面積增加為98.28%.
結(jié)論 　非侵入性的尿脫落細(xì)胞嗜銀染色結(jié)合B超聯(lián)合診斷膀胱移行細(xì)胞癌經(jīng)尿道手術(shù)后復(fù)發(fā)的價(jià)值較高,可常規(guī)用于術(shù)后病例的隨訪.

引用本文： 魏 強(qiáng),張慶江,張秀輝. 尿脫落細(xì)胞嗜銀染色結(jié)合B超聯(lián)合診斷膀胱癌經(jīng)尿道手術(shù)后復(fù)發(fā). 中國(guó)循證醫(yī)學(xué)雜志, 2005, 05(9): 681-683. doi: 復(fù)制

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