经尿道等离子针状电极整块切除膀胱肿瘤的初步经验(附31例报告)

Initial experience of transurethral needle electrode en bloc resection of bladder tumor:report of 31 cases

目的使用等离子针状电极对膀胱肿瘤经尿道做整块切除,并小结初步经验,分析其临床疗效。方法对2013年1月至2016年12月期间31例接受经尿道等离子针状电极膀胱肿瘤整块切除患者的临床资料做回顾性分析。全部研究对象术前均接受膀胱镜检明确肿瘤位置、数量及大小,CT检查提示膀胱肿瘤无明确肌层浸润及淋巴结转移。采用等离子针状电极在距离肿瘤基底1cm处对肿瘤进行整块切除,将包括肿瘤基底的全层膀胱壁送病检。对手术时间、闭孔神经反射发生率、并发症、肿瘤临床分期、术后复发率进行统计。结果 31例患者均顺利完成手术,每单个肿瘤的切除时间为3～35min,单个肿瘤平均手术时间(12.6±9.1)min;仅1例患者术中发生轻度闭孔神经反射。所有患者均未发生术后明显出血。结合影像学和术后病理结果进行临床分期,Ta期7例,T1期23例,T2a期1例。所有患者接受5～36个月随访,复发率为12.9%(4/31)。结论采用等离子针状电极可在术中整块切除膀胱肿瘤,可取得肿瘤的整体标本,同时能有效减少闭孔神经反射,可作为一种有效的治疗方式应用于膀胱肿瘤的腔内治疗。

Objective To summarize the clinical experience and analyse efficacy of transurethral needle electrode en bloc resection of bladder tumor.Methods A total of 31 patients with bladder tumor received transurethral needle electrode en bloc resection of bladder tumor from January 2013 to December 2016. Preoperative cystoscopy was performed to confirm the location, numbers and size of the tumors. No clear muscle invasion signs or lymph node metastasis were found by CT urography. After electrocautery of the bladder mucosa 1 cm away from the tumor base by coagulation current, the tumor as well as its basement were dissected in the plane between the muscular layer and the connective tissue. The specimens containing the tumor and full thickness of the bladder wall were obtained for pathological inspection. The operation time, obturator nerve reflex, complications and clinical stage of the tumor were observed.Results All 31 cases were performed by this procedure successfully. The operation time was 3-35 min per tumor [range, （12.6±9.1） min]. Obturator nerve reflex was observed in one case. No other complications occurred. The clinical stage of the tumors resected showed 7 tumors in T a stage, 23 tumors in T 1 stage and 1 tumor in T 2a stage. The recurrence rate was 12.9% （4/31）.Conclusions Transurethral needle electrode en bloc resection of bladder tumor is safe and effective. It also can provide sufficient specimens for pathological evaluation.