铥激光膀胱肿瘤整块切除术配合术中膀胱灌注治疗非肌层浸润性膀胱癌疗效分析

Thulium laser en bloc resection of bladder tumor combined with intravesical instillation for the treatment of non-muscle-invasive bladder cancer

目的:评价铥激光膀胱肿瘤整块切除术(thulium laser en bloc resection of bladder tumor,TLEBRBT)配合术中膀胱灌注治疗非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)的疗效。方法:研究对象为2012年4月~2014年10月于上海市第一人民医院泌尿外科中心行TLEBRBT且术后病理提示NMIBC的共计104例患者,配合术中即刻膀胱灌注吡柔比星。回顾性分析患者的手术时间、术中出血量、术中术后并发症、导尿管留置天数、术后病理分期分级。随访患者复发及进展情况并依据病理分级与分期分层统计患者复发率。结果:104例患者均行TLEBRBT,手术时间15~60min,平均(35.71±9.16)min;术中少量出血,无闭孔神经反射及膀胱穿孔发生,留置导尿1~4d。术后病理分期Ta74例,T130例。临床病理分级低度恶性潜能(PUNLMP)16例,低级别70例,高级别18例。随访时间6~35.5个月,平均(25.05±9.97)个月;复发13例(12.5%),平均复发时间(9.65±8.46)个月,死亡2例(1.9%)。结论:TLEBRBT配合术中膀胱灌治疗NMIBC安全、疗效确切、术后病理精确,是一种理想的手术治疗方式。

Objective：To evaluate the effect of thulium laser en bloc resection of bladder tumor（TLEBRBT）in combination with intravesical instillation in operation for the treatment of non-muscle-invasive bladder cancer（NMIBC）.Method：From April 2012 to October 2014,104 patients with NMIBC were included in this study.All patients received TLEBRBT under the general anesthesia,and intravesical chemotherapy with pirarubicin hydrochloride in operation.The operative time,intraoperative blood loss,days for urethral catheterization,incidence of postoperative complications,postoperative pathologic grade and stage,recurrence and progression were recorded.Result：All tumors in 104 patients were successfully removed with thulium laser en bloc resection.The operative time was 15-60min（mean,35.71±9.16min）,and there were less intraoperative blood loss.No obturator nerve reflex or bladder perforation was found.The catheter was removed 1-4days after operation.Postoperative pathological stages of all cases were distributed as 74 cases of Tastaging and 30 cases of T1 staging,put those in another way,16 cases of PUNLMP,70 cases of low grade urothelial carcinoma,18 cases of high grade.A total of 104 cases were followed up for 6-35.5months（mean,25.05±9.97months）.The recurrence rate was 12.5%（mean interval of recurrence 9.65±8.46 months）,and the mortality was 1.9%.Conclusion：The combination of TLEBRBT and intravesical chemotherapy in operation is an appropriate tool for the treatment of NMIBC,which is safe,efficacious and accurate for pathological grading and staging.