经尿道激光操作架直视推拨法铥激光整块切除术治疗非肌层浸润性膀胱癌的初步经验

The preliminary application of transurethral thulium laser en-bloc resection for the treatment of non-muscle invasive bladder cancer by laser controller

目的探讨应用激光操作架直视推拨法铥激光整块切除术治疗非肌层浸润性膀胱癌的技术特点及初步经验。方法回顾性分析2021年10月至2022年6月上海东方医院收治的57例NMIBC患者的临床资料,其中男性51例,女性6例,中位肿瘤直径2 cm(0.4~6 cm),肿瘤单发27例,多发30例。均应用激光操作架于肌纤维层面进行直视推拨,暴露肿瘤的基底部,如遇到血管,可激光电凝止血,如肌纤维无法推开,予激光切断,整块剜除肿瘤。结果57例手术均顺利完成。无中转传统TURBT手术,中位手术时间30 min(15~90 min)。术中无发生闭孔神经反射及明显膀胱穿孔。57例患者,共获取89个标本,有3个标本未能检测到逼尿肌,逼尿肌获取比例为96.6%(86/89)。有1个标本因为切缘组织烧灼而影响病理诊断,其余88个均未因为标本烧灼影响病理评估。结论激光操作架直视推拨法铥激光整块切除术技术可行,并发症发生率低,安全性高,标本存在逼尿肌比例高,且不容易出现标本烧灼影响病理评估。

Objective To evaluate the technique and preliminary experiences of thulium laser en bloc resection in the treatment of non-muscle invasive bladder cancer by laser controller.Methods The data of 57 patients with NMIBC admitted to Shanghai East Hospital from October 2021 to June 2022 were retrospectively analyzed,including 51 males and 6 females.The median tumor diameter was 2 cm(0.4~6 cm),27 patients had single tumor and 30 patients had multiple tumors.The muscle of the base of the tumor was pushed directly at the muscle fiber level by the laser controller.In case of bleeding or muscle fibers could not be pushed away,the fiber was extended to coagulate or cut off,and the tumor was eventually en-bloc resected.Results All 57 operations were successfully completed.There was no conversion to traditional TURBT.The median operation time was 30 min(range:15 min to 90 min).No obturator nerve reflex and obvious bladder perforation occurred during the operation.In 57 patients with 89 tumor specimens,detrusor muscle could not be detected in 3 specimens,and the proportion of detrusor muscle retrieval was 96.6%(86/89).The pathological diagnosis was affected by cauterization of the resection margin in 1 case specimen,and the pathological evaluation was not affected by cauterization of the remaining 88 specimens.Conclusion Bloc resection in the treatment of non-muscle invasive bladder cancer by laser controller is a feasible technique with low complication rate,high safety,high proportion of specimens with detrusor muscle,and low incidence of specimen cauterization,which will affect pathological evaluation.