光选择性汽化术治疗浅表性膀胱癌

Photoselective vaporization for the treatment of superficial bladder cancer

目的通过比较经尿道膀胱肿瘤电切术与经尿道光选择性膀胱肿瘤汽化术治疗浅表性膀胱癌的疗效,探讨光选择性汽化术治疗浅表性膀胱癌的疗效和安全性。方法2005年12月～2006年4月至我院就诊并行微创手术的40例浅表性膀胱癌患者,随机分为2组,20例患者接受经尿道电切术治疗,20例接受光选择性汽化术治疗。40例患者术后均接受同种常规灌注化疗并随访6个月。观察并比较两种治疗方法的手术时间、出血量、手术及术后并发症及术后随访6个月的复发情况。结果经尿道电切术组手术时间25～40min,平均(31.0±3.5)min;术中出血量4～8mL,平均(5.7±1.3)mL;2例术中出现闭孔神经反射,2例出现膀胱穿孔,3例出现术后肉眼血尿,术后6个月复查膀胱镜共复发2例。光选择性汽化术组手术时间20～40min,平均(27.0±5.3)min;术中出血量3～7mL,平均(4.5±1.1)mL;未发生闭孔神经反射及膀胱穿孔,未出现术后肉眼血尿,术后6个月复查膀胱镜共复发2例。结论光选择性汽化术是治疗浅表性膀胱癌的一种安全有效的微创手术,它具有操作简单、手术时间短、出血少、并发症少的优点,与经尿道电切术具有同等疗效,可望成为治疗浅表性膀胱癌的一种标准术式。

[Objective] To investigate the efficacy and safety of photoselective vaporization in the treatment of superficial bladder cancer by comparing the efficacy of photoselective vaporization with electrical resection in the treatment of superficial bladder cancer. [Methods] From Dec.2005 to April 2006, 40 patients with superficial blad- der cancer, who underwent micro-traumatic operation, were randomly divided into two groups. One group underwent the electrical resection of superficial bladder cancer, and the other group underwent the photoselective vaporization of superficial bladder cancer. All the patients accepted the routine post-operation chemical therapy, and all the patients bad been followed up for 6 months. We observed and compared the following variables such as the operation time, blood loss, operative complications and the relapse of the bladder cancer in 6 months of following up. [Restilts] In the group of electrical resection, the mean operative time was （31±3.5）min （range 25-40 min）, the mean blood loss was （5.7±1.3） mL （range 4-8 mL）, obturator nerve reflection happens in 2 cases, perforation of bladder happens in 2 cases, gross hematuria occurs in 3 cases post-operation, and 2 cases relapse in 6 months. In the group of the photoselective vaporization ,the mean operative time was （27±5.3）min （range 20-40 min）, the mean blood loss was （4.5±1.1）mL （range 3-7 mL）, obturator nerve reflection, perforation of bladder and gross hematuria did not occur, and 2 cases relapse in 6 months. [Conclusions] The photoselective vaporization is an excellent treatment for superficial bladder cancer. It has many advantages such as minimal injury, short operative time, few blood loss and few complication. It has the same efficacy with the electrical resection of the superficial bladder cancer, and it seems to be an attractive alternative to standard treatment.