针状电极经尿道切除直径大于3cm膀胱肿瘤的临床观察
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摘要
目的经尿道切除直径>3cm的膀胱肿瘤是电切手术的难点之一。本研究目的是探讨经尿道切除膀胱内大体积肿瘤的新方法。方法采用精准经尿道膀胱肿瘤切除技术,对26例膀胱肿瘤患者(肿瘤最大直径>3cm)进行经尿道切除,均未行闭孔神经阻滞。首先以针状电极在距肿瘤基底周边0.5～1cm处正常膀胱黏膜电灼作为标志,然后将针尖插入膀胱肌层,向远离膀胱壁方向牵拉、切断。完整剥离肿瘤后,自电切镜电极通道置入胃镜下息肉切除器的钢丝圈,将肿瘤套住后,保留镜鞘,连同镜体向外牵拉,完整取出肿瘤。如果肿瘤直径过大不能拉出,则继续用力牵拉、收紧钢丝圈,将瘤体切割为2～4份,再分别取出。记录手术时间、有无闭孔神经反射、肿瘤病理分期及有无复发等。结果所有患者均顺利完成精准经尿道膀胱肿瘤切除,肿瘤位于膀胱侧壁未进行闭孔神经阻滞。肿瘤最大直径3.0～6.0cm,单枚肿瘤切除时间20～75min,平均(42.4±20.3)min。术中均未发生闭孔神经反射,无膀胱穿孔等并发症,切除的肿瘤均获得完整病理分期。结论精准经尿道膀胱肿瘤切除是膀胱肿瘤切除手术的全新方法,在切除膀胱内较大肿瘤时具有独特的优势。
Objective To explore a reliable method for the transurethral resection of large bladder tumors.MethodsAccurate transurethral resection of the bladder tumor was performed in26 patients with bladder cancer(maximal tumor diameter>3 cm).The operation was performed without obturator nerve block.The peritumor mucosa was marked with a needle electrode 0.5-1 cm from the tumor.After that,the needle was punched into the muscle layer and the muscle bundles were stretched away from the lateral bladder wall,and then the electroresection current was cut off.After complete resection of the tumor,the gastroscope polyp excider was inserted into the channel of the resectoscope sheath.After capture of the tumor,the resectoscope sheath was kept in situ and the traptor was pulled out to pull out the tumor en bloc.If the tumor was too large,the traptor would be tightened until the tumor was cut into 2-4 pieces and then removed.The operation time,obturator nerve reflex,tumor pathological stage as well as recurrence were recorded.Results All patients underwent successful transurethral resection of bladder tumor.The tumors which nested in the side wall of the bladder were resected without obturator nerve block.The maximum tumor diameter ranged 3.0-6.0cm.Single tumor resection time was 20-75(average 42.4±20.3)min.No bladder perforation or intraoperative obturator nerve reflex occurred.Accurate pathological staging of every tumor was obtained.Conclusion Accurate transurethral resection of the bladder tumor is a novel method to remove bladder tumor.It has unique advantages in the transurethral resection of large tumors.
Objective To explore a reliable method for the transurethral resection of large bladder tumors.MethodsAccurate transurethral resection of the bladder tumor was performed in26 patients with bladder cancer(maximal tumor diameter>3 cm).The operation was performed without obturator nerve block.The peritumor mucosa was marked with a needle electrode 0.5-1 cm from the tumor.After that,the needle was punched into the muscle layer and the muscle bundles were stretched away from the lateral bladder wall,and then the electroresection current was cut off.After complete resection of the tumor,the gastroscope polyp excider was inserted into the channel of the resectoscope sheath.After capture of the tumor,the resectoscope sheath was kept in situ and the traptor was pulled out to pull out the tumor en bloc.If the tumor was too large,the traptor would be tightened until the tumor was cut into 2-4 pieces and then removed.The operation time,obturator nerve reflex,tumor pathological stage as well as recurrence were recorded.Results All patients underwent successful transurethral resection of bladder tumor.The tumors which nested in the side wall of the bladder were resected without obturator nerve block.The maximum tumor diameter ranged 3.0-6.0cm.Single tumor resection time was 20-75(average 42.4±20.3)min.No bladder perforation or intraoperative obturator nerve reflex occurred.Accurate pathological staging of every tumor was obtained.Conclusion Accurate transurethral resection of the bladder tumor is a novel method to remove bladder tumor.It has unique advantages in the transurethral resection of large tumors.
引文
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[7]宋伟宁,徐阿祥,孙圣坤,等.经尿道针状电极膀胱部分切除术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.
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[9]GONTERO P,SYLVESTER R,PISANO F,et al.Prognostic factors and risk groups in T1G3non-muscle-invasive bladder cancer patients initially treated with Bacillus Calmette-Guerin:results of a retrospective multicenter study of 2451patients[J].Eur Urol,2015,67(1):74-82.
[10]KIM YJ,BYUN SJ,AHN H,et al.Comparison of outcomes between trimodal therapy and radical cystectomy in muscle-invasive bladder cancer:apropensity score matching analysis[J].Oncotarget,2017,8(40):68996-69004.
[11]GERARDI MA,JERECZEK-FOSSA BA,ZERINI D,et al.Bladder preservation in non-metastatic muscle-invasive bladder cancer(MIBC):a single-institution experience[J].Ecancermed Sci,2016,10:657.
[12]ALAVI CE,ASGARI SA,FALAHATKAR S,et al.Effectiveness of spinal anesthesia combined with obturator nerve blockade in preventing adductor muscle contraction during transurethral resection of bladder tumor[J].Turk J Urol,2017,43(4):507-511.
[13]OH KJ,CHOI Y-D,CHUNG HS,et al.A novel transurethral resection technique for superficial flat bladder tumor:grasp and bite technique[J].Korean J Urol,2015,56(3):227-232.
[14]XU Y,GUAN W,CHEN W,et al.Comparing the treatment outcomes of potassium-titanyl-phosphate laser vaporization and transurethral electroresection for primary nonmuscle-invasive bladder cancer:aprospective,randomized study[J].Lasers Surg Med,2015,47(4):306-311.
[15]ALAVI CE,ASGARI SA,FALAHATKAR S,et al.Effectiveness of spinal anesthesia combined with obturator nerve blockade in preventing adductor muscle contraction during transurethral resection of bladder tumor[J].Turk J Urol,2017,43(4):507-511.
[16]YANG D,XUE B,ZANG Y,et al.Effcacy and safety of potassium-titanyl-phosphate laser vaporization for clinically non-muscle invasive bladder cancer[J].Urol J,2014,11:1258-1263.
[17]NASELLI A,INTROINI C,GERMINALE F,et al.En bloc transurethral resection of bladder lesions:a trick to retrieve specimens up to 4.5cm[J].BJU Int,2012,109(6):960-963.
[2]KAMAT AM,BACIOLU M,HURI E.What is new in nonmuscle-invasive bladder cancer in 2016?[J].Turk J Urol,2017,43(1):9-13.
[3]SUREKA SK,AGARWAL V,AGNIHOTRI S,et al.Is en-bloc transurethral resection of bladder tumor for non-muscle invasive bladder carcinoma better than conventional technique in terms of recurrence and progression?:A prospective study[J].Indian J Urol,2014,30(2):144-149.
[4]BRAUERS A,BUETTNER R,JAKSE G.Second resection and prognosis of primary high risk superficial bladder cancer:is cystectomy often too early?[J].J Urol,2001,165(3):808-810.
[5]郝保良,孙圣坤,彭亮,等.精准经尿道膀胱肿瘤切除治疗膀胱侧壁肿瘤的临床研究[J].微创泌尿外科杂志,2016,5(1):22-25.
[6]SUN S,XU A,CHEN G,ZHANG X.Re:Monopolar versus bipolar transurethral resection of bladder tumors:a single center,parallel arm,randomized,controlled trial[J].J Urol,2015,193(1):371-372.
[7]宋伟宁,徐阿祥,孙圣坤,等.经尿道针状电极膀胱部分切除术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.
[8]YANG HW,SHI LX,CHEN GF,et al.Transurethral needle electrode resection of bladder tumor:a technique obtaining En Bloc resection and obviating obturator nerve stimulation[J].World J Nephrol Urol,2015,4(3):232-236.
[9]GONTERO P,SYLVESTER R,PISANO F,et al.Prognostic factors and risk groups in T1G3non-muscle-invasive bladder cancer patients initially treated with Bacillus Calmette-Guerin:results of a retrospective multicenter study of 2451patients[J].Eur Urol,2015,67(1):74-82.
[10]KIM YJ,BYUN SJ,AHN H,et al.Comparison of outcomes between trimodal therapy and radical cystectomy in muscle-invasive bladder cancer:apropensity score matching analysis[J].Oncotarget,2017,8(40):68996-69004.
[11]GERARDI MA,JERECZEK-FOSSA BA,ZERINI D,et al.Bladder preservation in non-metastatic muscle-invasive bladder cancer(MIBC):a single-institution experience[J].Ecancermed Sci,2016,10:657.
[12]ALAVI CE,ASGARI SA,FALAHATKAR S,et al.Effectiveness of spinal anesthesia combined with obturator nerve blockade in preventing adductor muscle contraction during transurethral resection of bladder tumor[J].Turk J Urol,2017,43(4):507-511.
[13]OH KJ,CHOI Y-D,CHUNG HS,et al.A novel transurethral resection technique for superficial flat bladder tumor:grasp and bite technique[J].Korean J Urol,2015,56(3):227-232.
[14]XU Y,GUAN W,CHEN W,et al.Comparing the treatment outcomes of potassium-titanyl-phosphate laser vaporization and transurethral electroresection for primary nonmuscle-invasive bladder cancer:aprospective,randomized study[J].Lasers Surg Med,2015,47(4):306-311.
[15]ALAVI CE,ASGARI SA,FALAHATKAR S,et al.Effectiveness of spinal anesthesia combined with obturator nerve blockade in preventing adductor muscle contraction during transurethral resection of bladder tumor[J].Turk J Urol,2017,43(4):507-511.
[16]YANG D,XUE B,ZANG Y,et al.Effcacy and safety of potassium-titanyl-phosphate laser vaporization for clinically non-muscle invasive bladder cancer[J].Urol J,2014,11:1258-1263.
[17]NASELLI A,INTROINI C,GERMINALE F,et al.En bloc transurethral resection of bladder lesions:a trick to retrieve specimens up to 4.5cm[J].BJU Int,2012,109(6):960-963.