2μm激光汽化切除术与双极等离子切除术治疗高龄高危非肌层浸润性膀胱尿路上皮癌的疗效比较

Comparison of 2micron laser vaporization resection and bipolar plasmakineticresection for the treatment of non muscle-invasive bladder cancer in the elderly patients at high-risk

目的:探讨2μm激光汽化切除术与双极等离子切除术治疗高龄高危非肌层浸润性膀胱尿路上皮癌的疗效及安全性。方法:回顾性分析105例高龄高危非肌层浸润性膀胱尿路上皮癌患者,采用2μm激光组62例,双极等离子组43例。对2组之间的手术时间、手术并发症、术后留置尿管及住院时间、术后复发率等进行比较。结果:所有病人均安全度过围手术期,两组相比术后留置尿管时间及术后住院时间的差异无统计学意义。两组术后均行膀胱灌注化疗,术后复发率亦无明显差异。2μm激光组无闭孔神经反射并发症发生,双极等离子组闭孔神经反射发生率为12%(5/43),差异具有统计学意义。两组之间的手术时间(15.7±4.6)min vs(9.8±3.5)min,2μm激光组手术时间略长。结论:2μm激光汽化切除术与双极等离子切除术治疗高龄高危非肌层浸润性膀胱尿路上皮癌同样具有良好疗效,2μm激光汽化切除术可避免闭孔神经反射手术并发症的发生,在手术安全性上更具优势。

Objective:To compare the efficacy of 2 micron laser vaporization resection and bipolar plasmakinetic resection for the treatment of non muscle- invasive bladder cancer in high- risk elderly. Methods:All 105 cases of non muscle- invasive bladder cancer in high- risk elderly during March 2009 to June 2013 were retrospectively studied. The patients were divided into 2 groups according to operative procedures:2 micron laser group(62 cases),transurethral plasma bipolar electric excision group(PKRBt group,43 cases). The indexes were compared including operation time,urinary indwelling catheter time and length of stay after operatio,relapse rate after operation,complications during operation. Results:Compared with bipolar plasmakinetic resection,the operative time was a bit longer in 2 micron laser group[(15. 7 ± 4. 6)min vs(9. 8 ± 3. 5) min]. The complication of obturator nerve reflex was statistically significant between two groups. There was no obturator nerve reflex in 2 micron laser group. Whereas the incidence of obturator nerve reflex was 12%(5 /43)in bipolar plasmakinetic resection group( P < 0. 05). There was no significant difference between the two groups in postoperative catheter indwelling time and postoperation hospitalization duration.All patients underwent intravesical chemotherapy,and the relapse rate was no significant difference between the two groups. Conclusion:2 micron laser vaporization resection for non muscle- invasive bladder cancer in the elderly patients at high- risk is as effective as bipolar plasmakinetic resection. Moreover 2 micron laser vaporization resection can aviod the occurrence of obturator nerve reflex,so it has some advantages on avoiding complications.