经尿道钬激光整块切除术治疗高危非肌层浸润性膀胱癌47例疗效及术后并发症与复发风险的观察

Effect of transurethral holmium laser bulk resection in treatment of 47 cases with high-risk non-muscle invasive bladder cancer and its effect on postoperative recovery,complications and recurrence risk

目的 探讨经尿道钬激光整块切除术治疗高危非肌层浸润性膀胱癌(NMIBC)的效果。方法 选取2019年1月至2021年5月承德医学院附属医院94例高危NMIBC病人进行前瞻性研究,按随机数字表法分组,各47例。对照组行经尿道膀胱肿瘤等离子电切术,观察组行经尿道钬激光整块切除术。比较两组手术相关指标、临床疗效、手术前后外周血循环肿瘤细胞(CTCs)计数、肿瘤标志物[癌胚抗原(CEA)、膀胱肿瘤抗原(BTA)、糖链抗原19-9(CA19-9)]、并发症及预后情况。结果 观察组术中出血量、膀胱冲洗、尿管留置及术后住院时间分别为(25.10±4.12)mL、(18.65±6.74)min、(19.57±3.48)h、(8.01±1.69)d,均优于对照组的(43.25±6.78)mL、(24.78±8.12)min、(35.24±5.12)h、(15.32±2.89)d(P<0.05);观察组总有效率87.23%高于对照组68.09%(P<0.05);术后72 h观察组外周血CTCs计数为5.47±2.00,低于对照组的8.96±3.12(P<0.05);术后3、6、12个月观察组血清BTA、CEA、CA19-9水平低于对照组(P<0.05);观察组并发症发生率6.38%(3例)低于对照组23.40%(11例)(P<0.05);术后随访1年,观察组病人1年无复发生存率97.83%(45/46)与对照组90.91%(40/44)比较,差异无统计学意义(P>0.05)。结论 经尿道钬激光整块切除术可提高高危NMIBC病人临床疗效,减少并发症,加速术后康复进程,并可减少外周血循环肿瘤细胞,降低肿瘤标志物水平。

Objective To investigate the effect of transurethral holmium laser bulk resection in the treatment of high-risk non-muscle invasive bladder cancer(NMIBC).Methods A prospective study was conducted on 94 high-risk NMIBC patients in the Affiliated Hos-pital of Chengde Medical College from January 2019 to May 2021.They were randomly assigned into two groups,with 47 cases in each group.The control group underwent transurethral bladder tumor plasma electrosection,while the observation group underwent transure-thral holmium laser bulk resection.The surgery-related indicators,clinical efficacy,and peripheral blood circulating tumor cell(CTC)count before and after surgery were compared between the two groups.The tumor markers[carcinoembryonic antigen(CEA),bladder tu-mor antigen(BTA),carbohydrate antigen 19-9(CA19-9)],the complications and prognosis of the two groups were compared.Results The intraoperative blood loss,bladder irrigation,indwelling catheter,and postoperative hospitalization time in the observation group were(25.10±4.12)mL,(18.65±6.74)min,(19.57±3.48)h,and(8.01±1.69)d,respectively,which were all superior to those in the con-trol group of(43.25±6.78)mL,(24.78±8.12)min,(35.24±5.12)h,and(15.32±2.89)d(P<0.05);the total effective rate in the observa-tion group was 87.23%,which was higher than that in the control group 68.09%(P<0.05);the peripheral blood CTCs count in the obser-vation group at 72 hours after surgery was 5.47±2.00,which was lower than that in the control group 8.96±3.12(P<0.05);the serum BTA,CEA,and CA19-9 levels in the observation group were lower than those in the control group at 3,6,and 12 months after surgery(P<0.05);the complication rate in the observation group was 6.38%,which was lower than that in the control group of 23.40%(P<0.05);after one year of follow-up,the one-year recurrence-free survival rate in the observation group was 97.83%(45/46)and in the control group was 90.91%(40/44),and the difference was not statistically significant(P>0.05).Conclusion Transurethral holmium laser bulk resection can improve the clinical efficacy of high-risk NMIBC patients,reduce complications,speed up the postoperative recovery pro-cess,reduce peripheral blood circulating tumor cells,and reduce tumor marker levels.