铥激光切除输尿管膀胱壁内段在根治性肾输尿管全切术中的疗效分析

Technique of thulium laser in managing bladder cuff in nephroureterectomy for upper urinary tract urothelium carcinoma

目的观察铥激光技术在上尿路尿路上皮癌手术中输尿管末端切除手术的疗效和安全性。方法通过对56例行上尿路尿路上皮癌手术治疗的临床资料随访观察，对部分手术标本进行封闭测压，建立输尿管封闭可耐受压力的测量，来比较铥激光技术和电切封闭效果的异同。结果56例临床资料的随访观察结果表明，开放手术（A组，n：23）分别与电切（B组，n=17）和铥激光（C组，n=16）两组比较，平均手术时间、平均出血量、平均住院时间差异均有统计学意义[（232±52）比（148±47）和（130±49）min，（358±81）比（136±74）和（145±70）ml，（13±3）比（11±4）和（10±3）d，均尸〈0．05]，而留置扁平管与导尿管的时间差异均无统计学意义（均P〉0．05），B、C两组则以上指标差异均无统计学意义。输尿管封闭效果测压试验，C组与B组两组封闭后的最大耐受压力差异无统计学意义[（116．4-21）比（139±32）cmH：O，P〉0．05]。结论对于上尿路尿路上皮癌，采用铥激光技术封闭并切除输尿管末端，其效果与电切封闭及开放手术类似，且具有创伤小、手术时间短和术后恢复快的优势。

Objective To explore the application of thulium laser （2 pm laser） in managing bladder cuff in nephrouretereetomy for upper urinary tract urothelium carcinoma （UUT-UC）. Methods The medical records of 56 patients undergoing nephroureterectomy at our hospital were reviewed retrospectively. The operative indicators, oncologie outcomes and clinicopathologic data were compared among the groups of open surgery （Group A ）, electric coagulation （Group B ） and thulium laser technique （Group C ）. Furthermore a model of burst pressure measurement was built to measure the different burst pressures of sealing distal ureter. Results The follow-up results： when the indicators of operative duration, intraoperative blood loss volume, removal time of drainage tube, removal time of catheter and hospital stays were compared among three groups, Group A had no statistical differences with Group B/C in terms of removal time of drainage tube and removal time of catheter. But significant statistical differences existed in terms of operative duration, intraoperative blood loss volume and hospital stays （ （ 232 ＋- 52 ） vs （ 148 ＋ 47 ） and （130 ±49） min, （358±81） vs （136 ±74） and （145 ±70） ml,（13±3） vs （11 ±4） and （10±3） d, all P 〈 O. 05 ）. No statistical differences existed between Groups B and C in terms of all the above indicators. Burst pressure measurement results： no statistical differences existed between Group C and B （（116±21） vs （139 ±32） cm H20, P 〉0.05）. Conclusions For the surgical treatment of UUT-UC, thulium laser technique has no difference in operation indicators and oncologie outcomes compared to open surgery. Besides, it has the advantages of improved spatial beam quality and more precise tissue incision.