经尿道钬激光膀胱肿瘤切除术对表浅层膀胱癌患者术中出血量及预后的影响

Effect of transurethral resection of bladder tumor with holmium laser on intraoperative bleeding volume and prognosis in patients with superficial bladder cancer

目的探讨经尿道钬激光膀胱肿瘤切除术对表浅层膀胱癌息者术中出血量及预后的影响。方法选取新乡医学院第三附属医院2013年9月至2016年1月收治的85例表浅层膀胱癌患者，根据手术术式不同分为对照组42例（给予经尿道膀胱肿瘤电切术治疗）与观察组43例（实施经尿道钬激光膀胱肿瘤切除术治疗），观察比较两组手术情况（膀胱冲洗时间、留置尿管时间、术中出血量）及手术创伤相关指标[胰岛素抵抗指数（HOMA—IR）、纤维蛋白原（FIB）、凝血酶原活动度（PTA）]，并比较两组并发症发生率及复发率。结果观察组术中出血量及留置尿管、膀胱冲洗时间均小于对照组，差异均有统计学意义（均P〈0．05）；观察组HOMA—IR低于对照组，FIB及PTA均高于对照组，差异均有统计学意义（均P〈0．05）；观察组并发症发生率为4．65％（2／43），低于对照组21．43％（9／42），差异有统计学意义（P〈0．05）；观察组复发率为2．33％（1／43），低于对照组19．05％（8／42），差异有统计学意义（P〈0．05）。结论经尿道钬激光膀胱肿瘤切除术治疗表浅层膀胱癌，效果显著，可减少术中出血量，改善患者手术创伤相关指标值及预后。

Objective To investigate the effect of transurethral resection of bladder tumor with holmium laser on intraoperative bleeding volume and prognosis in patients with superficial bladder cancer. Methods From September, 2013 to January, 2016, 85 patients with superficial bladder cancer treated at our hospital were divided into a control group （n=42） and an observation group （n=43）. The control group were treated with transurethral resection of bladder tumor; and the observation group were treated with transurethral resection of bladder tumor with holmium laser. The surgical conditions （bladder rinse time, catheter-indwelled time, and intraoperative bleeding volume）, surgical trauma related indicators [insulin resistance index （HOMA-IR）, fibrinogen （FIB）, and prothrombin activity （PTA）], and the incidence of complications of the two groups were compared. Results The intraoperative bleeding volume was lower, the catheter-indwelled time and bladder rinse time were shorter, the HOMA-IR was lower, and the levels of FIB and PTA were higher in the observation group than in the control group, with statistical differences （ all P 〈 0.05 ） . The incidence of complications in the observation group was 4.65% （2/43）, which was lower than that in the control group （21.43%, 9/42）, with a statistical difference （P 〈 0.05）. The recurrence rate was 2.33% （1/43） in the observation group and 19.05% （8/42） in the control group, with a statistical difference （P 〈 0.05））. Conclusion Transurethral resection of bladder tumor with holmium laser in the treatment of superficial bladder cancer is significantly effective and can reduce the intraoperative bleeding volume and improve the surgical trauma related indicators and prognosis.