Ho∶YAG激光治疗膀胱肿瘤的临床观察

Ho∶YAG Laser Treatment of Bladder Tumors

目的 总结应用Ho∶YAG 激光治疗膀胱肿瘤的疗效。方法 经B 超、CT、膀胱镜和组织病理学检查确诊的膀胱肿瘤患者36 例,男性33 例,女性3 例,年龄38 ～85 岁,平均60 岁。25例肿瘤为单发,11 例为多发,共59 枚肿瘤。肿瘤为T1 ～T2 期、G1 ～G2 级,直径0-5 ～4-0 cm 。经尿道插入Storz 膀胱镜,耻骨上穿刺,将Ho∶YAG 激光转换杆置入膀胱腔内,在电视监视下应用脉冲式Ho∶YAG 激光,采用接触式和准接触式方法切割、汽化肿瘤及肿瘤周围2 cm 范围内的正常膀胱粘膜,激光参数为1-5 J、10 Hz 和15 W。结果 手术全部成功,手术时间为10 ～45 min ,平均20 min 。术中、术后无出血、膀胱穿孔等并发症,创面无癌细胞残留,术中尿脱落细胞学检查未找到脱落癌细胞。术后随访12 ～25 个月,仅2 例异位再发,复发率为5 .6 % 。结论 Ho∶YAG 激光治疗膀胱肿瘤操作较简单,手术时间短,术中、术后无严重并发症,对患者打击小,年老体弱患者也可以安全应用,近期复发率较低,是治疗浅表膀胱肿瘤的有效方法。

Objective This article described operation methods and experiences using Ho∶YAG laser in treating superficial bladder tumors and analyzed its advantages in comparison with other therapy methods such as TURBT and Nd∶YAG laser. Methods Ho∶YAG laser was applied for treating 36 cases of bladder tumors which were confirmed by examinations of B ultrasonic, CT, cystoscopy and pathology with totally 59 tumors, including one case accompanying bladder stone. All tumors were of stage T 1-T 2 and tumor grade G 1-G 2. The tumor size was 0 5-4 0 cm. The handscript of Ho∶YAG laser was put into bladder by suprapubic transvesical trocar, Ho∶YAG laser (1 5 J, 10 Hz and 15 W) was used endoscopically to cut and vaporize bladder tumor with a 2 cm margin of normal bladder mucosa. Results Ho∶YAG laser was successfully used to treat 59 bladder tumors in 36 patients, There were no intraoperative complications such as bleeding, perforation, obturator spasms and delayed complications, and there was mild suffering of the patients. The cytological examination revealed no exfoliative cancer cells in urine taken intraoperationally. Histopathology of biopsies showed no cancer cells left. Operation time was apparently short (mean 20 minutes). Catheter time was also very short, about 1-3 days or without catheter at all. Conclusions It has been demonstrated that Ho∶YAG laser therapy is provided with advantages of simple procedure, short operation time, short hospitalization, short catheter time, rapid convalescence and no necessity of open operation. Due to mild injury to and rapid recovery of patients, it can be suitable for treatment of patients in elder age or in a poor condition with superficial bladder tumors.