半导体激光与等离子电切术治疗浅表性膀胱肿瘤的疗效比较

Comparative study of diode laser and plasma kinetic resection for treating superficial bladder tumor

目的探讨1 470nm半导体激光治疗浅表性膀胱肿瘤的临床疗效。方法将2012年1月至2014年1月收治的浅表性膀胱肿瘤患者216例,分为激光组和电切组,分别行1 470nm半导体激光和等离子电切术治疗,比较两组患者的疗效。结果激光组的手术时间、术中出血量、留置尿管时间及术后住院时间均明显小于电切组,且激光组术中和术后6h的血肾上腺素、去甲肾上腺素及血管紧张素Ⅱ水平均明显低于电切组(P<0.05)。激光组未发生闭孔神经反射和膀胱穿孔,总并发症发生率为5.1%,术后24个月膀胱肿瘤复发率为7.1%;电切组闭孔神经反射发生率为7.6%,膀胱穿孔发生率为1.7%,总并发症发生率为15.3%,术后24个月膀胱肿瘤复发率为17.8%;激光组的上述指标均明显低于电切组(P<0.05)。结论 1 470nm半导体激光手术治疗非浸润性膀胱肿瘤临床疗效确切,操作简单,术后并发症发生率低,安全性高,中远期复发率低,且对患者应激水平影响小。

Objective To investigate the clinical effect of the 1 470 nm diode laser for the treatment of superficial bladder tumor. Methods Two hundreds and sixteen patients diagnosed with superficial bladder tumor were treated in our hospital from January 2012 to January 2014 and divided into the laser group and electric cutting group. The two groups were treated by 1 470 nm diode laser and transurethral plasma kinetic resection respectively. The basic data and the observation indexes were compared be- tween the two groups. Results The operation time,intraoperative bleeding volume,indwelling catheter time and hospital stay time in the laser group were significantly less than those in the electric cutting group. The levels of epinephrine,norepinephrine and an- giotensin Ⅱ in operation and at postoperative 6 h in the laser group were significantly lower than those in the electric cutting group （P〈0.05）. The obturator nerve reflex and bladder perforation did not occur in the laser group,and the total complications occur- rence rate was 5.1 %, the bladder tumor recurrence rate in postoperative 24 months was 7.1 %. The obturator nerve reflex occurrence rate was 7.6% ,the vesical perforation rate was 1.7% ,the total complications occurrence rate was 15.3% ,the bladder tumor recurrence rate in postoperative 24 months was 17.8 % in the electric cutting group. The above indexes of the laser group were sig- nificantly lower than those of the electric cut group（P〈0.05）. Conclusion The 1 470 nm diode laser for the treatment of noninva- sive superficial bladder tumor has definitely curative effect,is easy to operate with low postoperative complication occurrence rate, high safety and low middle and long term recurrence rate,moreover has little influence on patientrs stress level.