经尿道激光剜除与电切治疗非肌层浸润性膀胱肿瘤围手术期的比较研究
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摘要
目的比较1470 nm激光经尿道膀胱肿瘤整块剜除术(laser en-bloc transurethral resection of bladder tumor,EBRBT)与经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)在治疗非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)围手术期的临床安全性。方法回顾性分析2016-10/2018-06月作者医院100例诊断为膀胱占位患者,行EBRBT或TURBT治疗,有80例确诊为尿路上皮癌,分为EBRBT组和TURBT组。EBRBT组40例中T1G1期有35例,T1G3期有5例,无原位癌(carcinoma insitu,CIS);TURBT组40例中T1G1期有34例,T1G3期有4例,Ta期2例。分析两组患者年龄,性别,卡氏行为状态评分表(Karnofsky performance scale,KPS)评分,肿瘤大小、位置,手术时间,出血量,闭孔神经反射发生率,膀胱穿孔发生率,术后膀胱冲洗时间,住院时间等围手术期资料。结果两组患者均顺利完成手术。两组手术时间比较无统计学差异(P>0.05)。EBRBT组和TURBT组术中出血量、闭孔神经反射发生率、膀胱穿孔发生率、术后膀胱冲洗时间、拔管时间、住院时间相比较,前者均优于后者,差异有统计学意义(P均<0.01)。结论 1470 nm激光EBRBT同TURBT相比,可以完整切除肿瘤,同时又具有出血少、住院时间短等优点,还能减少闭孔神经反射导致的膀胱穿孔的发生。
Objective To compare perioperative safety between laser en-bloc transurethral resection of bladder tumor(EBRBT) and transurethral resection bladder tumor(TURBT) in the treatment of the non-muscle invasive bladder cancer(NMIBC).Methods A total of 100 NMIBC patients with bladder occupying underwent EBRBT or TURBT in authors' hospital from October 2016 to June 2018 were retrospectively analyzed.Eighty patients who diagnosed with urothelial carcinoma were divided into EBRBT group and TURBT group.In EBRBT group(n=40),there were 35 cases of T1 G1,5 cases of T1 G3,all patients without carcinoma insitu(CIS).In TURBT group(n=40),there were 34 cases of T1 G1,4 cases of T1 G3 and 2 cases of Ta.The age,gender,Karnofsky performance scale(KPS) score,tumor size and location,operative time,blood loss,incidence of obturator nerve reflex,incidence of bladder perforation,postoperative bladder irrigation time,length of stay of two groups were analyzed.Results The operation was successfully completed in both groups.There was no significant difference in operation time between two groups(P>0.05).The blood loss,incidence of obturator nerve reflectance,incidence of bladder perforation,postoperative bladder irrigation time,extubation time and length of stay of EBRBT group were superior to TURBT group(all P<0.01).Conclusion Compared with the TURBT,the EBRBT can completely remove the tumor,reduce blood loss and length of stay.It can also reduce the incidence of bladder perforation caused by obturator nerve reflex.
Objective To compare perioperative safety between laser en-bloc transurethral resection of bladder tumor(EBRBT) and transurethral resection bladder tumor(TURBT) in the treatment of the non-muscle invasive bladder cancer(NMIBC).Methods A total of 100 NMIBC patients with bladder occupying underwent EBRBT or TURBT in authors' hospital from October 2016 to June 2018 were retrospectively analyzed.Eighty patients who diagnosed with urothelial carcinoma were divided into EBRBT group and TURBT group.In EBRBT group(n=40),there were 35 cases of T1 G1,5 cases of T1 G3,all patients without carcinoma insitu(CIS).In TURBT group(n=40),there were 34 cases of T1 G1,4 cases of T1 G3 and 2 cases of Ta.The age,gender,Karnofsky performance scale(KPS) score,tumor size and location,operative time,blood loss,incidence of obturator nerve reflex,incidence of bladder perforation,postoperative bladder irrigation time,length of stay of two groups were analyzed.Results The operation was successfully completed in both groups.There was no significant difference in operation time between two groups(P>0.05).The blood loss,incidence of obturator nerve reflectance,incidence of bladder perforation,postoperative bladder irrigation time,extubation time and length of stay of EBRBT group were superior to TURBT group(all P<0.01).Conclusion Compared with the TURBT,the EBRBT can completely remove the tumor,reduce blood loss and length of stay.It can also reduce the incidence of bladder perforation caused by obturator nerve reflex.
引文
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[12] 杨静,杨涛.在快速康复外科理念联合中医护理方面应用于膀胱肿瘤电切术患者的疗效观察[J].实用中西医结合临床,2017,17(7):155-156
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[14] 张心如,谷保军,谢弘,等.2μm激光与TURBT治疗非肌层侵润性膀胱肿瘤的对照研究[J].临床泌尿外科杂志,2010,25(6):408-411
[15] 夏术阶,王骙.从医学激光的物理特性谈泌尿外科手术方法的设计与建立[J].临床泌尿外科杂志,2014,29(1):1-4
[16] 白云金,李金洪,魏强.激光在非肌层侵润性膀胱癌中的应用[J].国际泌尿系统杂志,2014,34(3):393-396
[17] 卡依沙尔·托乎提,居来提·白克热,王龙,等.经腹股沟入路闭孔神经阻滞预防经尿道膀胱肿瘤电切术闭孔神经反射效果的临床研究[J].临床和实验医学杂志,2014,13(1):60-62
[18] 龚小新,杨勇,陈从波,等.去离子水注射在预防侧壁膀胱肿瘤电切闭孔反射中的应用[J].中国现代手术学杂志,2016,20(1):66-68
[2] Jemal A,Murry T,Samuels A,et al.Cancer statistics 2003[J].CA Cancer J Clin,2003,53(1):5-26
[3] Jemal A,Siegel R,Ward E,et al.Cancer statistics,2008[J].CA Cancer J Clin,2008,58(2):71-96
[4] 娜彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社,2014:24
[5] Kramer MW,Bach T,Wolters M,et al.Current evidence for transurethral laser therapy of non-muscle invasive bladder cancer[J].World J Urol,2011,29(4):433-442
[6] 潘铁军,刘波.非肌层侵润性膀胱癌的腔内手术治疗现状[J].现代泌尿生殖肿瘤杂志,2011,3(4):193-195
[7] 郭佳,刘修恒,胡云飞,等.直出1470nm半导体激光膀胱肿瘤剜除术治疗膀胱癌的疗效及安全性研究[J].国际泌尿系统杂志,2016,36(6):805-807
[8] 范晋海,吴开杰,曹建伟.直出绿激光膀胱肿瘤剜除术在非肌层侵润性膀胱癌中的应用及技术探讨(附光盘)[J].现代泌尿外科杂志,2015,4(20):211-213
[9] Xishuang S,Deyong Y,Xiangyu C,et al.Comparing thesafety and efficiency of conventional monopolar,plasmakinetic,andholmium laser transurethral resection of primary non-muscle invasive bladder cancer[J].J Endourol,2010,24(1):69-73
[10] Seitz M,Sroka R,Gratzke C,et al.The diode laser:a novel side-firing approach for laser vaporisalion of the human prostate--immediate efficacy and l-year follow-up[J].Ear Urol,2007,52(6):1717-1722
[11] 王帅,姜家康.浅谈膀胱癌的中医诊疗措施[J].世界最新医学信息文摘,2015,15(84):92-93
[12] 杨静,杨涛.在快速康复外科理念联合中医护理方面应用于膀胱肿瘤电切术患者的疗效观察[J].实用中西医结合临床,2017,17(7):155-156
[13] Soloway MS.Editorial comment on:EAU guidelines on non-muscle-invasive urothelial carcinoma ofthe bladder,the 2011 update[J].Euro Urol,2008,54(2):313-314
[14] 张心如,谷保军,谢弘,等.2μm激光与TURBT治疗非肌层侵润性膀胱肿瘤的对照研究[J].临床泌尿外科杂志,2010,25(6):408-411
[15] 夏术阶,王骙.从医学激光的物理特性谈泌尿外科手术方法的设计与建立[J].临床泌尿外科杂志,2014,29(1):1-4
[16] 白云金,李金洪,魏强.激光在非肌层侵润性膀胱癌中的应用[J].国际泌尿系统杂志,2014,34(3):393-396
[17] 卡依沙尔·托乎提,居来提·白克热,王龙,等.经腹股沟入路闭孔神经阻滞预防经尿道膀胱肿瘤电切术闭孔神经反射效果的临床研究[J].临床和实验医学杂志,2014,13(1):60-62
[18] 龚小新,杨勇,陈从波,等.去离子水注射在预防侧壁膀胱肿瘤电切闭孔反射中的应用[J].中国现代手术学杂志,2016,20(1):66-68