经尿道等离子体双极电切联合钬激光治疗侧壁较大膀胱肿瘤

Transurethral Resection of Bladder Tumor with Plasmakinetic(PKRBt)and Holmium Laser for Big Bladder Tumor in Sidewall

目的探讨经尿道等离子体双极电切联合钬激光治疗侧壁较大膀胱肿瘤的价值。方法回顾性分析30例侧壁较大膀胱肿瘤的临床资料,患者均接受了经尿道等离子体双极电切联合钬激光治疗。术前膀胱镜检查证实均为膀胱侧壁肿瘤,肿瘤直径均≥2cm,平均直径2.5cm。首先采用等离子电切切除瘤体,将肿瘤大部切除以缩短手术时间,直至暴露易发生闭孔神经反射的蒂部或发生较明显的闭孔神经反射,再改行钬激光切除直至深肌层。结果 30例膀胱肿瘤均顺利完成手术,手术时间较短,平均手术时间22min。术中发生闭孔神经反射18例,无膀胱穿孔病例。所有患者术中出血量少,未输血。术后均未膀胱冲洗,导尿管留置时间平均3天。随访624个月,8例复发,但无原位复发病例。结论对于较大的侧壁肿瘤,先以等离子电切除瘤体,然后更换钬激光切割肿瘤基底,这样既能快速切割肿瘤,缩短手术时间,又能减少闭孔神经反射,有较好的临床价值。

Objective To study the value of transurethral resection of bladder tumor with plasmakinetic（PKRBt）and holmium laser for big bladder tumor in sidewall. Methods We retrospectively reviewed clinical data of 30 patients with big bladder tumor in sidewall treated with PKRBt and holmium laser. All tumor were confirmed by cystoscopy before operation. The diameter of tumor were more than 2cm,and the average was 2.5cm. Tumor was resected by PKRBt until the exposure of basal body or had obvious obturator nerve reflex, then by holmium laser until to deep muscle layer of bladder. Results All the operation were successful, and the average surgery time was 22min. Obturator reflex happened in 18 cases, but no cases had bladder perforation. They had little bleeding, and no one need blood transfusion. No bladder douche were needed. Catheter indwelling were needed for average 3 days. All cases were followed up for 6 - 24 months. Recurrence happened in 8 cases, but none was in situ recurrence. Conclusion For big bladder tumor in sidewall, cooperation of PKRBt and holmium laser has advantage such as quickly resection and no serious obturator nerve reflex.