非肌层浸润性膀胱癌两种手术方法的疗效比较

Comparison of two surgical methods for treating non-muscle invasive bladder cancer

目的比较经尿道钬激光切除术与经尿道等离子电切术在非肌层浸润性膀胱癌治疗中的疗效及安全性。方法回顾性分析2010-01~2015-06在我院手术治疗的182例非肌层浸润性膀胱癌患者的临床资料,其中经尿道钬激光切除术组90例,经尿道等离子电切术组92例。分析比较两组患者的手术时间、术中出血量、术中闭孔神经反射与膀胱穿孔发生率、术后导尿管留置时间、住院时间及术后2年肿瘤复发率的差异。结果两组手术方式的手术时间及膀胱穿孔发生率无差异。就闭孔神经反射而言,经尿道钬激光切除术组发生率为0%,经尿道等离子电切术组发生率为26. 1%,两组差异有统计学意义(P <0. 05)。此外,经尿道钬激光切除术组术中出血量、术后导尿管留置时间、住院时间均显著低于经尿道等离子电切术组,且差异有统计学意义(P <0. 05)。结论相较于经尿道等离子电切术而言,经尿道钬激光切除术治疗非肌层浸润性膀胱癌止血效果更佳、安全性更高,是一种安全可行的、有望替代经尿道等离子电切术的手术方法。

Objective To compare the efficacy and safety in the treatment of non-muscle invasive bladder cancer using holmium laser resection of bladder tumor （HolRBT） and bipolar plasmakinetic transurethral resection of bladder tumor （bTURBT）. Methods The clinical data of 182 patients between January 2010 to June 2015, who had non-muscle invasive bladder cancer treated in our hospital, were analyzed retrospectively. Patients were divided into two groups, which including 90 cases in HolRBT group and 92 cases in bTURBT group. The time of operation, the amount of intraoperative bleeding, the incidence of obturator nerve reflex and bladder perforation, the time of catheter indwelling and hospitalization, as well as the recurrence rate of tumor in 2 years after operation were assessed and compared. Results There was no difference in operative time and incidence of bladder perforation between the two groups. The incidence of obturator nerve reflex was 0 in HolRBT group, which was significantly lower that of 26.1% in bTURBT group （P 〈 0.05）. In addition, the amount of intraoperative bleeding, the time of indwelling catheter and the time of hospitalization in HolRBT group were significantly lower than those in bTURBT group （P 〈 0.05）. Conclusion Compared with bTURBT, HolRBT has better hemostatic effect and higher safety in the treatment of non-muscle invasive bladder cancer. It is a well-tolerated and feasible alternative to bTURBT.