经尿道等离子针状电极膀胱肿瘤整块切除术的疗效观察

The clinical efficacy of transurethral plasma needle electrode en bloc resection of bladder cancer

目的总结经尿道等离子针状电极膀胱肿瘤整块切除术治疗膀胱癌的临床经验，分析该术式的临床效果。方法回顾性分析2015年2月至2016年8月我院收治的26例膀胱癌患者的病例资料。男21例，女5例。年龄42～75岁，平均（56±13）岁。肿瘤直径1～4cm，平均（2．3±1．6）cm。肿瘤单发19例；多发7例，其中2枚5例，3枚2例。6例肿瘤位于膀胱侧壁。术前活检病理诊断均为膀胱尿路上皮癌。术前CTU检查提示均无膀胱壁外浸润，上尿路均无肿瘤。26例均在硬膜外麻醉下行经尿道等离子针状电极膀胱肿瘤整块切除术，术中利用电极针状头端插入膀胱黏膜下方，钝性剥离结合钩切肿瘤基底肌肉条索，完整切除肿瘤，将标本取出后送病理检查。结果本组26例手术均顺利完成，切除肿瘤35枚，肿瘤大小1．0～4．0cm。手术时间20～50min，平均（30±16）min；单个肿瘤切除时间5—25min。术中出血量均〈10ml，均无闭孔神经反射发生。术后未发生并发症，无继发性出血。所有患者均接受吡柔比星30mg即刻膀胱灌注治疗，无明显不良反应。术后病理诊断均为非肌层浸润性膀胱癌，切缘均为阴性。病理分期分级：T1G1尿路上皮癌33枚，T1G3尿路上皮癌2枚。术后3个月复查膀胱镜示创面愈合良好。26例随访3～10个月，平均（6．0±2．3）个月，均无肿瘤复发。结论经尿道等离子针状电极膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌具有并发症少、有效降低闭孔神经反射、可获得精确病理分期等优点。

Objective To summarize the clinical experience and analyze the efficacy of transurethral plasma needle electrode en bloc resection for bladder cancer. Methods From February 2015 to August 2016, a total of 26 patients, including 21 males and 5 females, with bladder cancer received transurethral plasma needle electrode en bloc resection of bladder tumor. Their age ranged from 42 to 75 years,mean （56 ± 13）years. The size of tumor ranged from 1 to 4 cm, mean （2.3 ± 1.6）cm. The solitary tumor was found in 19 cases and multiple tumors were found in 7 cases, including 2 tumors in 5 cases, 3 tumors in 2 cases. In 6 cases, the tumor located in the lateral bladder wall. All the pre - operative biopsy showed the urethelial carcinoma in all cases, No bladder extravasion or upper urinary tumor was noticed in the CTU before surgery. By using the electrode needle tip inserted into the bladder mucosa, blunt release or cut the tumor bases until the deep muscularis or the serosal layer, complete removal of the tumor. The specimen was removed from the bladder and sent to the pathological examination. The operation time, the volume of blood loss during operation, surgical complications, pathological diagnosis and the wounds recovery were recorded and analyzed. Results All surgeries were undergone successfully. Totally 35 tumors were resected with diameter of t. 0 - 4.0 cm, mean （2.3 ± 1.6） cm. The estimated blood loss was less than 10 ml. The operative duration ranged from 20 to 50 min, mean （30 ± 16） rain. The duration for removing the single tumor ranged from 5 to 25 min. No obturator nerve reflex were observed during surgery. No blood loss and complications occurred after operation. All patients received 30 mg pirarubicin bladder instillation chemotherapy immediately and no adverse reaction was noticed. Postoperative pathological stages of enrolled cases were distributed as 33 cases of T1G1 staging, 2 cases of T1G3 staging. No positive margin was observed. 3 months afler ope,＇ation, eystoscopy showed that the wound healed well. A total of 26 cases followed up for 3-10 months （ mean 6.0 ± 2.3 months）. No one developed recurrence. Conclusions Transurelhral plasnm needle electrode en bloc resection of bladder tumor would reduce the incidence of eomplieations and obturator nerve reflex. It ean provide sufficient specimens for histological diagnosis.