经尿道2μm激光同期切除膀胱肿瘤和BPH的临床疗效分析

Effects of simultaneous transurethral resection of bladder tumor and prostate by using 2 micron continuous wave laser

目的：探讨经尿道2μm激光同期切除膀胱肿瘤和BPH的疗效及安全性。方法：回顾性分析2008年1月-2012年12月187例老年男性膀胱肿瘤患者，将其分为两组，第1组119例单纯行经尿道2μm激光膀胱肿瘤切除术，第2组68例在行经尿道2μm激光膀胱肿瘤切除术的同时行经尿道2μm激光前列腺切除术。分别比较了两组患者术前的临床特征、病理特征、手术时间和出血量，以及两组患者手术前后尿流率，剩余尿的变化情况，肿瘤复发及进展情况。结果：两组患者在年龄、临床分期、肿瘤大小和数量方面没有明显的差异，术后病理分级也无统计学差异，第2组患者在手术时间、术中失血、尿管留置时间上均较第1组长。两组随访时间中位数分别为35.3个月（第1组）和32.5个月（第2组），第2组的尿流率较术前及第1组显著升高，同时剩余尿较第1组明显降低，第2组复发率为29.41%，较第1组的36.97%有显著差异，比较发现单发的或小于3 cm的肿瘤患者其肿瘤复发率低于多发的或肿瘤〉3 cm的患者。同时两组均未在膀胱颈部及尿道前列腺部发现有肿瘤复发。结论：对于伴有下尿路梗阻症状的非肌层浸润性膀胱肿瘤患者，采用2μm激光同时经尿道切除膀胱肿瘤和BPH是安全可靠的，不会增加膀胱颈部和前列腺尿道部肿瘤种植的风险。同时在解除膀胱颈部的梗阻后，能降低或延缓膀胱肿瘤的复发。

Objective： To evaluate the safety and efficacy of simultaneous transurethral bladder tumor and prostate resection by using 2 micron continuous wave laser in patients with nonmuscle invasive bladder tumor and BPH. Method： From January 2008 to December 2012, there were 187 patients with nonmuscle invasive bladder tumor, including 119 patients with transurethral resection of bladder tumor only （group 1） and 68 patients with simultaneous transurethral bladder tumor and prostate resection using 2 micron continuous wave （group 2）. The data were retrospectively analyzed including preoperative characteristics, pathologic characteristics, operative time, blood loss, tumor recurrence and progression between the two groups. The change of maximum flow rate and the postvoid residual volume were also compared between the two groups before and after operation. Result： There was no significant differences in age, clinical stage, the number and the size of the tumor, pathologic grade between the two groups. The operative time and catheterization time were longer in group 2 than in group 1 （P〈 0.05）. The mean follow-up time was 35.3 and a2.5 months in groups 1 and 2, respectively. The recurrence rate in groups 1 and groups 2 was 36.97% and 29.41% respectively （P〈0. 05）. Patients with tumor less than 3 cm or a single tumor had a much lower recurrence rate than patients with tumor larger than 3 cm or multiple tumor. None of the patients was found recurrence in the bladder neck or prostatic urethra. Three months after surgery the postvoid residual volume had significantly decreased in group 2 and maximum flow rate was significantly higher in group 2. Conclusion： Simultaneous transurethral resection of bladder tumor and prostate by 2 micron continuous wave laser in patients with nonmuscle invasive bladder tumor and BPH is a safe and efficient way. It may help decrease bladder cancer recurrence without the risk of cancer implantation when transurethral prostate resection is done.