经尿道荧光膀胱镜下膀胱肿瘤整体切除术的临床观察

Clinical observation of total resection of bladder tumor with transurethral fluoroscopy

目的探讨经尿道荧光膀胱镜下膀胱肿瘤整体切除术治疗膀胱肿瘤的临床方法。方法选取2014年1月~2015年12月在徐州市中心医院诊治的40例膀胱肿瘤患者。采用骶管阻滞麻醉,共切除肿瘤45枚,其中单发肿瘤36例,肿瘤直径0.5~2 cm,均位于膀胱后壁或颈口位置。先荧光膀胱镜下观察膀胱内肿瘤大小及部位,再用等离子沿肿瘤近端切开膀胱壁全层达膀胱外脂肪,然后向远端全层切除,最后切除肿瘤远端完整切除肿瘤及其基底部膀胱全层。结果 40例患者均顺利完成手术,手术时间10~40 min,平均(23.95±8.39)min,术中出血量极少,术后无继发性出血,术后肿瘤病理分期T1期34例,T2期6例,术后随访12~24个月,平均(14.89±1.97)个月,无肿瘤复发。结论经尿道荧光膀胱镜下膀胱肿瘤整体切除术能完整切除肿瘤及肿瘤基底,并且荧光下可以对可疑膀胱壁进行预防性切除,手术效果确切。

Objective To investigate the clinical method of transurethral resection of bladder tumor with cystoscopy in the treatment of bladder tumor. Methods From January 2014 to December 2015, 40 patients with bladder cancer who were treated at Xuzhou Central Hospital were observed. All the patients were treated with sacral obstruction anesthesia. 45 cases of tumor were removed, including 36 cases of tumor were single tumor, and the tumor diameter was 0.5-2 cm, which were located in the posterior wall of the bladder or the location of the neck. Firstly, the tumor size and location of the bladder were observed by flimrescent cystoseopy. Then the bladder wall full of bladder fat was cut by the plasma along the tumor proximal, along the tumor in full-thickness resection, the final resection of the tumor distal complete resection of the tumor and its basal bladder full-thickness pathology. Results 40 patients were successfully completed operation, and the operation time was 10-40 rain, the mean time was （23.95±8.39） rain. The intraoperative blood loss was very few, and there was no secondary bleeding after operation. 34 cases were postoperative tumor stage T1 and 6 cases were postoperative tumor stage.T2. Patients were followed up 12-24 months after operation, the mean time was （14.89±1.97） months, no tumor case was recurred. Conclusion Transurethral resection of bladder tumor under eys- toscopy can completely remove the tumor and tumor base, which can prevent the removal of the suspected bladder wall under fluorescence, and the surgery effect is exact.