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

Denudation of bladder mucos by needle electrode in the treatment of superficial peri-ureteral orifice bladder tumors

目的：探讨经尿道针状电极膀胱肿瘤切除术中采取膀胱黏膜剥脱法处理输尿管口旁肿瘤的可行性及疗效。方法：5例膀胱肿瘤患者,肿瘤均位于输尿管开口10cm内。采用硬膜外麻,以等离子针状电极距肿瘤周边1cm电凝正常膀胱黏膜后,将针尖插入黏膜下层,将肿瘤所在部位膀胱黏膜完整剥脱,观察手术时间、术中闭孔神经反射发生情况、术中及术后并发症、肿瘤病理分期。结果：共切除输尿管口旁肿瘤5枚,单枚肿瘤切除时间5~15min,平均(78±62)min；所有病例均未行闭孔神经阻滞,术中均无闭孔神经反射发生,术中出血极少,术后无继发出血,留置尿管24~48h 。切除肿瘤均获得完整病理分期：Ta 期4枚,T1期1枚。随访3~6个月未见肿瘤复发,无输尿管反流、输尿管口狭窄、肾及输尿管积水等并发症发生。结论：经尿道针状电极膀胱肿瘤切除术采用黏膜剥脱法治疗输尿管口旁浅表性膀胱肿瘤,其操作简单,创伤小,并发症少,但远期疗效尚需进一步观察。

To-investigate-the-feasibility-and-effect-of-mucosa-denudati-on-during-transurethral-needle-e-lectrode-resecti-on-of-bladder-tumor-(TUNER--BT)in-the-treat-ment-of-superficial-peri--ureteral-orifice-bladder-tumors-.-Methods-:5-patients-with-bladder-tumors-l-ocated-1-cm-peri--ureteral-orifice-were-incl-uded-.The-patients-recei-ved-epi-dural-anesthesia-.After-electrocautery-of-the-nor-mal-bladder-mucosa-1-cm-a-way-from-the-tumor-by-coagulati-on-cur-rent-,the-needle-tip-was-inserted-into-the-sub-mucosa-layer-and-the-bladder-tumor-as-well-as-the-mucosa-was-stri-pped-en-bloc-.The-operati-on-time-,obturator-nerve-reflex-,peri-operati-ve-complications-,and-pathol-ogic-stage-of-the-tumors-were-observed-.Results-:5-peri--ureteral-orifice-bladder-tumors-were-resected-with-the-operati-ve-time-of-5-1-5-min-per-tumor-(range-,7??8-±6??2-min-).Obturator-nerve-blockade-is-not-necessary-in-any-case-and-no-obturator-nerve-reflex-occurred-.Peri-operati-ve-bl-ood-l-oss-was-mini-mal-.The-urine-drainage-retained-24-48-h-.The-pathol-ogic-stage-of-tumors-sho-wed-4-in-Ta-,and-1-in-T1-.No-tumor-recurrence-and-no-complications-such-as-stricture-of-uretero-vesical-orifice-,-hydronephrosis-or-vesicoureteral-refl-ux-occurred-during-a-follow--up-of-3-6-months-.Conclusions-:Denudati-on-of-the-bladder-mucosa-by-TUNER--BT-is-a-si-mple-and-reliable-method-during-treat-ment-of-superficial-bladder-tumors-l-oca-ted-near-the-ureteral-orifice-.Ho-wever-,the-long-ter-m-oncol-ogic-outco-mes-re-main-to-be-defined-.