经尿道膀胱镜钬激光治疗膀胱癌——附37例报告

Holmium Laser Treatment of Bladder Tumor Via Cystoscope:a Report of 37 Cases

目的探讨经尿道膀胱镜钬激光治疗膀胱癌的疗效。方法膀胱癌患者37例，经尿道膀胱镜，以波长2100nm、频率15～40Hz、功率15—40w、能量15J钬激光切除肿瘤。术后1周开始膀胱灌注盐酸表柔比星进行化疗。结果全部病例手术均成功。无膀胱穿孔和闭孔神经反射发生。1例术后尿道狭窄，定期扩张后治愈。2例肿瘤位于输尿管开口2cm内的患者术后随访无复发，无输尿管肿瘤种植，无输尿管狭窄及反流等。5例患者术后复发，膀胱镜检查显示异位复发，无原位复发；组织病理学检查确诊后再次行经尿道膀胱镜钬激光膀胱肿瘤切除术，术后灌注羟基喜树碱，随访9个月，无复发。结论经尿道膀胱镜钬激光治疗膀胱癌是一种安全、微创、出血量极少的治疗方法，疗效显著，并发症少。

Objective To evaluate method of holmium laser treatment of bladder tumor via cystoscope. Methods Thirty-seven cases of bladder tumor were treated with holmium laser via cystoseope from Jan,2005 to Jun,2007. Chemothera- py with epiruhicin hydrochloride was used one week after operation.Results All patients underwent the treatment procedure successfully. There was no case of vesical perforation and reflex of obturator nerve. Stricture happened in 1 case which was cured by dilation of urethra. There was no relapse, plantation, ureterostenoma or backstreaming in 2 cases whose tumor was shorter than 2 cm to ureteral orifice. Relapse of other position happened in 5 cases. There was no relapse in situ. The relapse cases underwent another holmium laser treatment via cystoscope and chemotherapy with hydroxycamptothecin was used. There was no relapse after 9 months follow-up. Conclusions Holmium laser is a safe method for bladder tumor. It has good treatment effect and belongs to minimally invasive operation. There is little side effect. It is worth of wide spread.