2微米激光治疗非肌层浸润性膀胱肿瘤的疗效分析

Efficacy analysis of 2-micron laser treatment in non muscle-invasive bladder cancer

目的探讨2微米激光治疗非肌层浸润性膀胱肿瘤的近期临床效果。方法非肌层浸润性膀胱肿瘤患者56例。男44例,女12例,中位年龄66岁(28～87岁)。肿瘤单发36例,多发20例。肿瘤直径0.5～3.0cm,术前病理均提示低级别尿路上皮癌。所有患者随机平均分为2微米激光治疗组和经尿道电切组。术后行羟基喜树碱膀胱灌注治疗。总结比较两组的手术时间、导尿管留置时间、术后膀胱冲洗时间、肿瘤复发情况和膀胱穿孔例数等指标。结果手术均一次成功,所有患者术中创面基底及创缘病理检查均无残余肿瘤,全部患者均得到随访,随访时间3～8个月,每3个月接受膀胱镜复查。2微米激光组手术时间是20～50min,平均30min。术后膀胱冲洗6h,留置尿管1～3d,无膀胱穿孔病例,3例复发(10.71%)。电切组手术时间是15～55min,平均28min,术后膀胱冲洗6h,导尿管留置时间1～3d,膀胱穿孔6例,4例复发(12.00%)。两组的平均手术时间、尿管留置时间、膀胱冲洗时间和术后肿瘤复发等指标的差异均无统计学意义(P>0.05),2微米激光组膀胱穿孔例数少于电切组(P<0.001)。结论经尿道2微米激光治疗非肌层浸润性膀胱肿瘤的近期疗效满意,创伤更小,患者耐受良好。

Objective To study the short-term clinical effect of 2-micron laser in patients with non muscle-invasive bladder cancer.Methods There were 44 male patients and 12 females with an average age of 66 years（ranged 28-87 years）.The tumor lesion is single in 36 and multiple in 20 patients.The diameter of the tumor was 0.5-3.0 cm,and the patients were pathologically confirmed to be low grade papillary urothelial carcinoma by biopsy before surgery.56 patients with non muscle-invasive bladder cancer were randomly assigned to be treated by 2-micron laser or electrocautery transurethral resection.Used hydroxy camptothecin bladder instillation after surgery,and compared operative time,indwelling urethral catheter time,bladder washing,bladder perforation and postoperative recurrence.Results The procedure has been successful in all,postoperative biopsies of the tumor base and incisional margins were negative.All patients in were followed up for 3-8 months,and postoperative all the patients underwent cystoscopy every three months.In 2-micron laser groups,the mean operating time was 30 min（ranged 20-50 min）.The bladder washing had been done for 6 h after surgery,and indwelling urethral catheter time ranged from 1-3 days,and 3 cases（10.71%） of tumor recurrence was found.In electrocautery transurethral resection groups,the mean operating time was 28 min（ranged 15-55 min）.The bladder washing had been done for 6 h after surgery,and indwelling urethral catheter time ranged from 1-3 days,and 4 cases（12.00%） of tumor recurrence was found,but 6 cases had bladder perforation.The mean operative time,indwelling urethral catheter time,bladder washing and postoperative recurrence were not significantly different between the 2 groups （P0.05）,however,compared with electrocautery resection group,no cases had bladder perforation in 2-micron laser group （P0.001）.Conclusions 2-micron laser treatment provides a useful clinical therapeutic method for non muscle-invasive bladder cancer that has the advantages of safety and minimal invasion in short-term,and the patients could tolerate the surgery.