抗凝治疗患者经尿道膀胱肿瘤电切术安全性与疗效分析

The Safety and Efficacy of Transurethral Resection of Bladder Tumor in Patients on Anticoagulant

目的探讨接受抗凝治疗患者行经尿道膀胱肿瘤电切术(TURBT)的安全性和疗效。方法经尿道膀胱肿瘤电切术治疗30例接受抗凝治疗的非肌层浸润性膀胱癌患者,术前5 d停服华法林或阿司匹林,改为静脉低分子肝素,术后5 d恢复口服华法林或阿司匹林;术前10 d停服氯吡格雷,改为静脉低分子肝素抗凝,术后5 d再恢复口服氯吡格雷。术后应用吡柔比星膀胱灌注化疗。监测术中、术后有无出血、血栓性疾病及手术并发症。术后随访1～3年。结果全部患者均一次手术成功,平均手术时间25 min,术中1例膀胱穿孔,术后3例膀胱明显出血,无尿道狭窄发生。随访期间4例复发,均为异位复发,无一例患者死亡。结论在围手术期合理应用抗凝剂情况下,抗凝治疗患者经尿道膀胱肿瘤电切术是安全和有效的。

Objective To investigate the safety and efficacy of transurethral resection of bladder tumor（TURBT） in patients on anticoagulant.Methods Thirty cases of patients on anticoagulant with non muscle-invasive bladder cancer were treated by transurethral resection.Warfarin and aspirin were withheld 5 days before operation with enoxaparin bridging and resumed 5 days after operation.Clopidogrel was stopped 10 days before operation and resumed 5 days after operation.All the patients received intravesical instillation of pirarubicin postoperatively and had been followed up for 1-3 years.Results All the patients had been operated successfully.The average operation time was 25 min.During surgery 1 patient had bladder perforation,3 patients had significant bleeding.No patients had urethral stricture.During follow-up 4 patients had recurrence,all of them were ectopic recurrence.None of the patients died.Conclusion With carefully perioperative regulation of anticoagulation therapy and clotting parameters,TURBT can be performed safely and efficiently in properly selected patients requiring long-term anticoagulation.