经尿道2μm激光膀胱部分切除术治疗膀胱尿路上皮癌组织病理学分析

Histopathologic analysis of 2 micron continuous wave laser for the partial cystectomy of bladder urothelial carcinoma

目的观察应用2μm激光行经尿道行膀胱部分切除术治疗膀胱肿瘤的组织病理学特点。方法2007年10月至2008年12月采用经尿道膀胱镜行2μm激光膀胱部分切除术治疗54例膀胱肿瘤患者，男性41例，女性13例，年龄27—81岁，平均（66．2±12．4）岁；共有肿瘤65个。术中全层汽化切割瘤体周围膀胱壁至膀胱壁最外层的疏松结缔组织，将切取的全层标本送病理检查。观察术后组织形态学改变。结果54例患者均可耐受手术。术后肿瘤临床分期：T1期42例，T2期12例。术后随访1—14个月，平均8．5个月，复发2例，无原位复发。组织病理学示瘤体及其附着的膀胱黏膜、黏膜下层及全部肌层完整切除，切缘无残留，标本可清楚判定肿瘤分期。术后1周手术创面呈凹陷状，为纤维结缔组织伴慢性炎细胞浸润；术后1个月创面凹陷变浅，并出现移行上皮细胞覆盖，其下为纤维结缔组织；至术后3个月创面凹陷基本消失，黏膜稍苍白；术后6个月观察创面黏膜与周围膀胱壁黏膜基本一致。结论2μm激光治疗膀胱肿瘤可达到膀胱部分切除术的临床效果，肿瘤及萁附着的陪胱壁伞肌．屡可完整切除．所得标本可准确判守肿瘤的临床分期．术后创面恢复良好。

Objective To observe the histopathologic characteristics of 2 micron continuous wave laser transurethral partial cystectomy for the treatment of bladder tumor. Methods A total of 54 patients with 65 bladder tumors underwent 2 micron laser via transurethral by caudal or surface anesthesia from October 2007 to December 2008. It included 41 male and 13 female cases, and the age ranged from 27 to 81 years old with a mean of （66. 2 ± 12. 4） years old. The operation evaporated and exsected the wall of urinary bladder, including tumor, submucosa and all muscular layers. Specimens were sent for pathology examination. The histomorphologic changes of raw surfaces were observed 1 week, 1 month, 3 months, 6 months and 1 year postoperation by cystoscopic and pathologic examinations. Results All the patients tolerated in the operation. Clinical stages of the tumor： T1 for 42 cases, T2 for 12 cases. All cases were followed-up for 1 to 14 months, with a mean of 8.5 months. Tumor recurrences were found in 2 cases, no one had recurrence in situ. The tumor, submucosa and all muscular layers can be resected completely by 2 micron continuous wave laser transurethral partial cystectomy. Pathologic staging can be judged correctly. The umbilication raw surface were infiltrated by fibrous connective tissue and chronic inflammatory cells 1 week postoperation. The umbilication changed shallow and transitional epithelial cells began to cover it 1 month postoperation. The umbilication dispeared and transitional epithelial cells cover the raw surface 3 months postoperation. There was no difference between the raw surface and normal bladder mucosa. Conclusions 2 micron continuous wave laser for the treatment of bladder tumor can get the same clinical result as partial cystectomy. The pathologic staging can be judged correctly by the specimens.