经尿道等离子针状电极剜除术治疗非肌层浸润性膀胱肿瘤的临床分析
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摘要
目的探讨等离子针状电极剜切术治疗非肌层浸润性膀胱癌的技术特点及应用。方法选择经膀胱镜病理检查确诊的初发非肌层浸润性膀胱癌38例,在全身麻醉或者连续硬膜外麻醉下行等离子针状电极整块剜除术,术中剜除肿瘤后在膀胱内注入无菌蒸馏水200mL,保留膀胱灌注30min,留置尿管。术后行膀胱灌注规范化疗,观察手术剜切时间、出血量、术中闭孔神经反射发生情况以及术后尿管留置时间及并发症发生、术后复发等情况。结果本组男31例,女7例,年龄26~78岁;肿瘤直径0.5~3.0cm,肿瘤数目1~3个。所有患者均手术剜切术成功,手术时间5~45min,术中出血量轻微,发生闭孔反射3例,无膀胱穿孔发生,术后尿管留置时间2~5d;5例多发肿瘤患者,术后4~6周再次行剜除术。随访3~24个月,4例出现异位复发。结论等离子针状电极剜切术治疗非肌层浸润性膀胱癌整块切除,简单、安全、并发症少、疗效满意、设备门槛低、便于基层医院开展。
Objective To explore the technical characteristics and applications of pin-shaped plasmakinetic electrode in the transurethral resection of non-muscle invasive bladder carcinoma.Methods A total of 38 pathologically confirmed nonmuscular invasion bladder cancer patients received operation under general or epidural anesthesia.After the tumor was removed,200 mL sterile distilled water was infused into the bladder,kept for 30 min,and then urethral catheterization was indwelt.All patients underwent regular urinary bladder irrigation chemotherapy.The operation time,blood loss,postoperative urine tube indwelling time and complications were observed.Results The patients included 31 males and 7 females,aged 26-78 years.The tumor diameter ranged0.5-3.0cm,and the tumor number ranged1-3.All operations were successful.The operation time was 5-45 min,with slight bleeding during operation.Obturator nerve reflex was observed in3 cases,but no bladder perforation occurred.The urethral catheterization time was 2-5 days.For the 5 patients who had more than1 tumor,a second operation was conducted4-6 weeks later.During the follow-up of 3-24 months,relapses occurred in4 cases.Conclusion Pin-shaped plasmakinetic electrode surgery is safe,effective and cheap for non-muscular invasion bladder cancer,which causes few complications but produces favorable prognosis.Its applicable in basic-level hospitals.
Objective To explore the technical characteristics and applications of pin-shaped plasmakinetic electrode in the transurethral resection of non-muscle invasive bladder carcinoma.Methods A total of 38 pathologically confirmed nonmuscular invasion bladder cancer patients received operation under general or epidural anesthesia.After the tumor was removed,200 mL sterile distilled water was infused into the bladder,kept for 30 min,and then urethral catheterization was indwelt.All patients underwent regular urinary bladder irrigation chemotherapy.The operation time,blood loss,postoperative urine tube indwelling time and complications were observed.Results The patients included 31 males and 7 females,aged 26-78 years.The tumor diameter ranged0.5-3.0cm,and the tumor number ranged1-3.All operations were successful.The operation time was 5-45 min,with slight bleeding during operation.Obturator nerve reflex was observed in3 cases,but no bladder perforation occurred.The urethral catheterization time was 2-5 days.For the 5 patients who had more than1 tumor,a second operation was conducted4-6 weeks later.During the follow-up of 3-24 months,relapses occurred in4 cases.Conclusion Pin-shaped plasmakinetic electrode surgery is safe,effective and cheap for non-muscular invasion bladder cancer,which causes few complications but produces favorable prognosis.Its applicable in basic-level hospitals.
引文
[1]VAN DEN BOSCH S,ALFRED WITES J.Long term cancer specific survival in patients with high risk non muscle invasive bladder cancer and tumor progression:a systematic review[J].Eur Urol,2011,60(3):493-500.
[2]SIEGEL R,MA J,ZOU Z,et al.Cancer statistics(2014)[J].CA Cancer J Clin,2014,64(1):9-29.
[3]曾甫清,蒋国松.非肌层浸润性膀胱癌的规范治疗[J].临床泌尿外科杂志,2015,29(4):287-290.
[4]宋伟宁,徐阿祥,孙圣坤,等.经尿道针状电极治疗膀胱尿路上皮癌(附4例报告)[J].微创泌尿外科杂志,2013,2(6):396-398.
[5]DOBRUCH J,DANESHMAND S,FISCH M,et al.Gender and bladder cancer:A collaborative review of etiology,biology,and outcomes.Eur Urol,2016,69(2):300-10.
[6]贺大林,吴开杰,范晋海.肌层非浸润型膀胱肿瘤激光治疗的现状与展望[J].现代泌尿外科杂志,2015,20(6):373-375.
[7]孙圣坤,张旭.经尿道膀胱肿瘤切除术的研究进展[J].微创泌尿外科杂志,2014,3(6):380-384.
[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浸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,2015,20(4):211-213.
[9]程永毅,孙羿,屈卫星,等.经尿道内镜黏膜下剥离术治疗非肌层浸润性膀胱肿瘤临床分析[J].现代泌尿生殖肿瘤杂志,2015,6(3):136-140.
[10]李建昌,张凌君,孙圣坤,等.针状电极膀胱黏膜剥脱治疗输尿管口旁浅表性膀胱肿瘤5例报告[J].微创泌尿外科杂志,2014,6(3):171-174.
[11]左玉良,王朝明.经尿道膀胱肿瘤电切术中闭孔神经反射的防治[J].中华实用诊断与治疗杂志,2011,4(9):923-924.
[2]SIEGEL R,MA J,ZOU Z,et al.Cancer statistics(2014)[J].CA Cancer J Clin,2014,64(1):9-29.
[3]曾甫清,蒋国松.非肌层浸润性膀胱癌的规范治疗[J].临床泌尿外科杂志,2015,29(4):287-290.
[4]宋伟宁,徐阿祥,孙圣坤,等.经尿道针状电极治疗膀胱尿路上皮癌(附4例报告)[J].微创泌尿外科杂志,2013,2(6):396-398.
[5]DOBRUCH J,DANESHMAND S,FISCH M,et al.Gender and bladder cancer:A collaborative review of etiology,biology,and outcomes.Eur Urol,2016,69(2):300-10.
[6]贺大林,吴开杰,范晋海.肌层非浸润型膀胱肿瘤激光治疗的现状与展望[J].现代泌尿外科杂志,2015,20(6):373-375.
[7]孙圣坤,张旭.经尿道膀胱肿瘤切除术的研究进展[J].微创泌尿外科杂志,2014,3(6):380-384.
[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浸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,2015,20(4):211-213.
[9]程永毅,孙羿,屈卫星,等.经尿道内镜黏膜下剥离术治疗非肌层浸润性膀胱肿瘤临床分析[J].现代泌尿生殖肿瘤杂志,2015,6(3):136-140.
[10]李建昌,张凌君,孙圣坤,等.针状电极膀胱黏膜剥脱治疗输尿管口旁浅表性膀胱肿瘤5例报告[J].微创泌尿外科杂志,2014,6(3):171-174.
[11]左玉良,王朝明.经尿道膀胱肿瘤电切术中闭孔神经反射的防治[J].中华实用诊断与治疗杂志,2011,4(9):923-924.