钬激光治疗非肌层浸润性膀胱肿瘤的疗效与安全性评价

Safety and efficacy of Holmium laser resection for primary non-muscle invasive bladder cancer versus transurethral electroresection

目的 以TURBt作为对照,评价经尿道钬激光膀胱肿瘤切除术（HoLRBt）治疗非肌层浸润性膀胱肿瘤的疗效与安全性. 方法 回顾性研究212例原发性膀胱肿瘤患者临床资料.按治疗方式分为HoLRBt组（n=101）和TURBt组（n=111）,每组患者按复发风险分为低、中及高危3个亚组.比较2组患者术前、术中和术后相关临床指标,Kaplan-Meier分析比较2组整体及每个亚组的无复发生存率（RFS）. 结果 2组患者性别、年龄、肿瘤特点、复发风险等比较差异均无统计学意义（P＞0.05）.HoLRBt组未发生闭孔神经反射,TURBt组发生闭孔神经反射7例（6.3%）、膀胱穿孔3例（2.7%）.HoLRBt组术后需要膀胱冲洗患者比例（23.8%）、留置尿管时间[（1.4±0.5）d]和术后住院时间[（2.9±0.7）d]均＜TURBt组（P＜0.05）,后者分别为36.9%、（2.5±0.9）d、（4.4±1.1）d.平均随访34（18～43）个月,Kaplan-Meier分析HoLRBt与TURBt组RFS差异无统计学意义（P=0.283）.其中HoLRBt组1、2、3年RFS分别为81.4%、69.5%、56.5%,TURBt组分别为75.6%、60.1%、45.2%.结论 HoLRBt治疗非肌层浸润性膀胱肿瘤近期RFS与TURBt相近,术中并发症及术后恢复时间优于TURBt.

Objective To evaluate the safety and efficacy of Holmium laser resection for primary non-muscle invasive bladder cancer （HoLRBt） compared with transurethral resection of bladder tumor （TURBt）. Methods Data of 212 patients with primary non-muscle invasive bladder cancer were collected retrospectively. The patients were divided into HoLRBt group（n= 101） and TURBt group （n= 111）. The patients in each group were stratified into 3 risk groups （low, intermediate and high risk） according to prognostic factors for recurrence based on EAU guideline. Then, the safety of HoLRBt and TURBt groups were compared, concerning the intraoperative complications and postoperative recovery. Efficacy indicated by recurrence-free survival of the 2 groups was analyzed and compared by Kaplan-Meier technique. Results Patients＇ demographics including age, gender, tumor characteristics, and recurrence risk of tumor between the 2 groups were comparable（P〉0.05）. No obturator nerve reflex occurred in the HoLRBt group. Meanwhile, 7 out of 111 patients in the TURBt group experienced this complication resulted bladder perforation in 3 patients. The proportion of patients needing postoperative bladder irrigation in the HoLRBt group was lower compared to the TURBt group （P〈0.05）. HoLRBt was associated with shorter postoperative catheter drainage period （P〈0.05）. The mean postoperative follow-up was 34 months （range 18 to 43）. Recurrence-free survival after HoLRBt was similar with that of TURBt （P = 0. 283）. Conclusions Compared with TURBt, HoLRBt is a feasible, safe and effective alternative for the management of primary non-muscle invasive bladder cancer with similar therapeutic efficacy and fewer perioperative complications.HoLRBt can be widely used in clinical practice in the treatment of primary non-muscle invasive bladder cancer.