经尿道2μm激光膀胱部分切除术治疗膀胱肿瘤的初步探讨

Initial experience of partial cystectomy in treatment of bladder tumor by 2 μm continuous wave laser （18 cases）

目的分析应用经尿道2μm激光行膀胱部分切除术治疗膀胱肿瘤的临床特点。方法采用骶管麻醉，经尿道膀胱镜2μm激光行膀胱部分切除术治疗18例膀胱肿瘤患者，共切除肿瘤21个，肿瘤直径大小1-3em。术中用2μm激光沿肿瘤周围全层切开膀胱壁，在肌层与外层结缔组织之间剥离整块膀胱壁，完整切除肿瘤及其基底部膀胱全肌层标本送病理检查。观察手术时间，术中出血情况，术中及术后并发症，肿瘤病理分期以及术后随访。结果18例患者均可耐受手术，本组患者手术时间5～12min，平均（7．4±3．3）min；术中出血量极少或几乎不出血，无闭孔神经反射，术后亦无继发出血，1例术后出现尿外渗，给予置管引流；术后肿瘤病理分期：T1期15例患者，共18个肿瘤，1、2期：3例患者，共3个肿瘤；术后随访3～6个月，平均4．5个月，无原位复发。结论2μm激光能对膀胱壁全层进行精确的汽化切割，并且可以在肌层与疏松结缔组织之间进行剥离，在膀胱肿瘤治疗中达到膀胱部分切除的目的。

Objective To analyze the clinical characteristics of partial cystectomy in treatment of bladder tumor by 2μm continuous wave laser. Methods A total of 18 patients with 21 bladder tumors treated by 2μm laser via transurethral under sacral block. The diameters of tumors were between 1-3 cm. In the operation, we vaporized and cut whole wall of bladder, dissected the muscular layers from connective tissue,and sent them for pathology inspection. We overviewed these following variables： operation time, blood loss, complications during and after the operation, pathology staging of the tumor and follow-up visit. Results All the patients were tolerated in the operation. The mean operative time was （7.4 ± 3.3 ） rain （range,5-12 min）. Blood loss in the operation was minimal. No patient experienced an obturator nerve reflection or a hemorrhage after the operation. One case has urine leakage. The pathology staging of the tumors were as follows：T1 stage 15 cases,total 18 tumors; and T2 stage 3 cases,total 3 tumors. The followup periods were between 3 to 6 months, and the mean period was 4.5 months. There was no recurrence in situ. Conclusions The 2 μm laser not only can vaporize and cut the wall of bladder finely, but also can dissect the muscular layers from connective tissue efficiently. So it can be partial cystectomy in the treatment of bladder tumor.