经尿道双极等离子针状电极与环状电极治疗非肌层浸润性膀胱癌的疗效对比分析
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摘要
目的:对比分析经尿道双极等离子针状电极与环状电极治疗非肌层浸润性膀胱癌的疗效。方法:选取2016年9月～2017年8月经泌尿系彩超、膀胱镜检查并行病理活检确诊为尿路上皮癌,CTU检查提示无膀胱壁外浸润且上尿路无侵及的中等大小(直径1.0～3.0cm)膀胱肿瘤患者66例纳入研究样本,按照住院顺序随机分为2组,其中针状电极组33例,环状电极组33例。将两组手术出血量、尿管留置时间、住院时间、闭孔神经反射发生率、病理标本深度及术后随访4～17个月的复发率进行统计学分析。结果:66例手术均由同一位高年资医师完成,手术采用全身麻醉,均未行闭孔神经区域阻滞,分别以针状电极与环状电极完整切除肿瘤,瘤体标本完整。比较两组手术出血量、尿管留置时间、住院时间、闭孔神经反射发生率、病理标本深度及术后随访4～17个月的复发率,针状电极组均小于环状电极组(P<0.05)。结论:经尿道等离子针状电极整块切除术治疗非肌层浸润性膀胱肿瘤具有非常大的潜力,具有安全有效,技术及设备门槛低,精准整块切除、减少转移及种植、损伤小,闭孔神经反射少,利于精确病理分期等优点。
Objective:To compare the efficacy of transurethral bipolar plasma needle electrode vs.annular electrode in the treatment of non muscle-invasive bladder cancer.Methods:From September 2016 to August 2017,66 cases of urothelial carcinoma admitted in our hospital were diagnosed by urological color Doppler ultrasound and cystoscopy parallel biopsy.The CTU examination suggested no invasion of the bladder wall and no invasion of the upper urinary tract(diameter of 1.0-3.0 cm),and according to the order of hospitalization,the patients were divided into 2 groups,including needle electrode group(33 cases)and ring electrode group(33 cases).The surgical bleeding,catheter indwelling time,hospitalization time,the incidence of obturator nerve reflex,the depth of pathological specimen,and the recurrence rate during the posotoperative follow-up of 4-17 months were statistically analyzed.Results:All operations of the 66 cases were performed successfully under the geneal anesthesia by the same senior resident physician.No block of the obturator nerve area was performed.The tumor was completely removed with needle electrode and ring electrode,and the tumor specimen was complete.The rate of bleeding,indwelling time of urethral catheter,hospital stay,the incidence of obturator nerve reflex,the depth of pathological specimen,and the recurrence rate during the postoperative follow-up of 4-17 months were compared between the two groups.Those in needle electrode group were superior to the ring electrode group(P<0.05).Conclusions:Pin-shaped bipolar plasmakinetic electrode used in transurethral en bloc resection of non muscle-invasive bladder urothelial carcinoma is safe and effective,has low threshold of the technology and equipment,can precisely and completely remove the tumor and reduce the metastasis and planting,has little injury and obturator nerve reflex,and is conducive to accurate staging,etc.
Objective:To compare the efficacy of transurethral bipolar plasma needle electrode vs.annular electrode in the treatment of non muscle-invasive bladder cancer.Methods:From September 2016 to August 2017,66 cases of urothelial carcinoma admitted in our hospital were diagnosed by urological color Doppler ultrasound and cystoscopy parallel biopsy.The CTU examination suggested no invasion of the bladder wall and no invasion of the upper urinary tract(diameter of 1.0-3.0 cm),and according to the order of hospitalization,the patients were divided into 2 groups,including needle electrode group(33 cases)and ring electrode group(33 cases).The surgical bleeding,catheter indwelling time,hospitalization time,the incidence of obturator nerve reflex,the depth of pathological specimen,and the recurrence rate during the posotoperative follow-up of 4-17 months were statistically analyzed.Results:All operations of the 66 cases were performed successfully under the geneal anesthesia by the same senior resident physician.No block of the obturator nerve area was performed.The tumor was completely removed with needle electrode and ring electrode,and the tumor specimen was complete.The rate of bleeding,indwelling time of urethral catheter,hospital stay,the incidence of obturator nerve reflex,the depth of pathological specimen,and the recurrence rate during the postoperative follow-up of 4-17 months were compared between the two groups.Those in needle electrode group were superior to the ring electrode group(P<0.05).Conclusions:Pin-shaped bipolar plasmakinetic electrode used in transurethral en bloc resection of non muscle-invasive bladder urothelial carcinoma is safe and effective,has low threshold of the technology and equipment,can precisely and completely remove the tumor and reduce the metastasis and planting,has little injury and obturator nerve reflex,and is conducive to accurate staging,etc.
引文
[1]黄健,梁朝朝,周利群,等.膀胱癌诊断治疗指南.北京:人民卫生出版社,2014:37-38.
[2] Engilbertsson H,Aaltonen KE,Bjornsson S,et al.Transurethral bladder tumor resection can cause seeding of cancer cells into the bloodstream.J Urol,2015,193(1):53-57.
[3] Maruniak NA,Takezawa K,Murphy WM.Accurate pathological staging of urothelial neoplasms requires better cystoscopic sampling.J Urol,2002,167(6):2404-2407.
[4] Sharma D,Singh VP,Agarwal N,et al.Obturator nerve block in transurethral resection of bladder tumor.a comparative study by two techniques.Anesth Essays Res,2017,11(1):101-104.
[5] Holzbeierlein JM,Smith J.Surgical management of noninvasive bladder cancer(stages Ta/T1/CIS).Urol Clin North Am,2000,27(1):15-24.
[6] Jones JS,Larchian WA,Campbell-Walsh urology.PA:Elsevier Saunders,2011:2335-2338.
[7] Kramer MW,Abdelkawi IF,Wolters M,et al.Current evidence for transurethral en bloc resection of non-muscle-invasive bladder cancer.Minim Invasive Ther Allied Technol,2014 23(4):206-213.
[8] Ukai R,Hashimoto K,Iwasa T,et al.Transurethral resection in one piece(TURBO)is an accurate tool for pathological staging of bladder tumor.Int J Urol,2010,17(8):708-714.
[9] Lee MC,Levin HS,Jones JS.The role of pathology review of transurethral bladder tumor resection specimens in the modern era.J Urol,2010,183(3):921-927.
[10]Poletajew S,Fus,Waldziak M,et al.Comparison of pathological staging and grading of urothelial bladder carcinoma in post-transurethral resection and post-radical cystectomy specimens. Pol J Pathol,2014,65(4):305-312.
[11]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.微创泌尿外科杂志,2016,5(1):22-25.
[12]邹伟波,张浩,陈征,等.经尿道肿瘤整块切除用于初发膀胱癌的精准分期与治疗.中华腔镜泌尿外科杂志(电子版),2016,10(4):4-7.
[13]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癌的初步经验.微创泌尿外科志,2014,3(2):108-111.
[14]王伟录,李巧星,王勇,等.硬膜外麻醉联合膀胱穿刺局部麻醉在膀胱侧壁肿瘤电切术中的应用.现代泌尿外科杂志,2017,22(2):116-118.
[2] Engilbertsson H,Aaltonen KE,Bjornsson S,et al.Transurethral bladder tumor resection can cause seeding of cancer cells into the bloodstream.J Urol,2015,193(1):53-57.
[3] Maruniak NA,Takezawa K,Murphy WM.Accurate pathological staging of urothelial neoplasms requires better cystoscopic sampling.J Urol,2002,167(6):2404-2407.
[4] Sharma D,Singh VP,Agarwal N,et al.Obturator nerve block in transurethral resection of bladder tumor.a comparative study by two techniques.Anesth Essays Res,2017,11(1):101-104.
[5] Holzbeierlein JM,Smith J.Surgical management of noninvasive bladder cancer(stages Ta/T1/CIS).Urol Clin North Am,2000,27(1):15-24.
[6] Jones JS,Larchian WA,Campbell-Walsh urology.PA:Elsevier Saunders,2011:2335-2338.
[7] Kramer MW,Abdelkawi IF,Wolters M,et al.Current evidence for transurethral en bloc resection of non-muscle-invasive bladder cancer.Minim Invasive Ther Allied Technol,2014 23(4):206-213.
[8] Ukai R,Hashimoto K,Iwasa T,et al.Transurethral resection in one piece(TURBO)is an accurate tool for pathological staging of bladder tumor.Int J Urol,2010,17(8):708-714.
[9] Lee MC,Levin HS,Jones JS.The role of pathology review of transurethral bladder tumor resection specimens in the modern era.J Urol,2010,183(3):921-927.
[10]Poletajew S,Fus,Waldziak M,et al.Comparison of pathological staging and grading of urothelial bladder carcinoma in post-transurethral resection and post-radical cystectomy specimens. Pol J Pathol,2014,65(4):305-312.
[11]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.微创泌尿外科杂志,2016,5(1):22-25.
[12]邹伟波,张浩,陈征,等.经尿道肿瘤整块切除用于初发膀胱癌的精准分期与治疗.中华腔镜泌尿外科杂志(电子版),2016,10(4):4-7.
[13]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癌的初步经验.微创泌尿外科志,2014,3(2):108-111.
[14]王伟录,李巧星,王勇,等.硬膜外麻醉联合膀胱穿刺局部麻醉在膀胱侧壁肿瘤电切术中的应用.现代泌尿外科杂志,2017,22(2):116-118.