经尿道2μm激光膀胱部分切除术与经尿道膀胱肿瘤电切术治疗T1G3膀胱癌的疗效比较

Comparison of effect of partial-cystectomy with 2-micron laser treatment and transurethral electroresection in T1G3 bladder cancer

目的回顾性分析比较经尿道2μm激光膀胱部分切除术与经尿道膀胱肿瘤电切术治疗T1G3膀胱癌的疗效,了解前者的技术特点和优势。方法在我科2009年1月-2013年12月的浅表性膀胱癌病例中筛选出T1G3膀胱癌49例,分别采用经尿道2μm激光膀胱部分切除术(n=23)与经尿道膀胱肿瘤电切术(n=26)。将两组术中、术后并发症、二次活检阳性率及术后复发率进行统计学分析。结果电切治疗组术中发生闭孔反射6例、膀胱穿孔2例,术后发生血尿、严重膀胱刺激征明显多于2μm激光治疗组(P<0.05);2μm激光治疗组二次活检无阳性结果,电切治疗组二次活检阳性率23.1%(6/26),术后肿瘤总复发率激光治疗组明显低于电切治疗组(21.7%vs 42.3%,P<0.05)。结论经尿道2μm激光膀胱部分切除术并发症明显少于经尿道膀胱肿瘤电切术组,切除肿瘤彻底,作为保留膀胱的微创手术,在治疗T1G3膀胱癌方面有优势。

Objective To compare the clinical efficacy of partial-cystectomy with 2-micron laser and transurethral electroresection in T1G3 bladder cancer and investigate the technique advantages of partial-cystectomy with 2-micron laser treatment.Methods Of the 49 patients with T1G3 bladder cancer in our hospital from January 2009 to December 2013, 23 cases were treated by partial-cystectomy with 2-micron laser and 26 cases were treated by transurethral electroresection. Their intraoperative and postoperative complications, positive rate and postoperative recurrence were analyzed.Results Obturator nerve reflex occurred in 6 cases and bladder perforation in 2 cases in the transurethral electroresection group, hemoturia and severe irritation sign of bladder were also found in the transurethral electroresection group, which were obviously more than that in partial-cystectomy with 2-micron laser group （P〈0.05）. In partial-cystectomy with 2-micron laser group, all cases were negative for second-biopsy, and the positive rate of second-biopsy in transurethral electroresection group was 23.1% （6/26）. The total tumor recurrence rate of partial-cystectomy with 2-micron laser group was obviously lower than transurethral electroresection group （P〈0.05）.Conclusion The complication of partial-cystectomy with 2-micron laser group is significantly less than that of transurethral electroresection group. Partial-cystectomy with 2-micron laser is a safe and efficient procedure for the treatment of T1G3 bladder cancer.