Ho:YAG激光治疗浅表性膀胱肿瘤的临床观察

Ho:YAG laser treatment of superficial bladder tumors

目的 总结应用Ho :YAG激光治疗浅表性膀胱肿瘤的方法及疗效。方法 术前经膀胱镜、病理诊断为浅表性膀胱肿瘤患者 5 2例 ,单发 3 9例 ,多发 13例。肿瘤共 87个。经膀胱镜置入光纤 ,直视下应用脉冲式Ho :YAG激光切除 ,汽化膀胱肿瘤及其肿瘤基底周围膀胱粘膜。结果 5 2例中 ,9例局麻下门诊完成 ,术后未留置导尿管。 43例留置导尿管 1～ 3d。手术时间 10～40min ,平均 2 5min ,术后创面无瘤细胞残留。术中术后无出血、膀胱穿孔、闭孔神经反射等并发症。 7例输尿管口肿瘤术后输尿管口无狭窄 ,输尿管无种植。 5 0例术后随访 3～ 3 1个月 ,6例复发 ,复发率 12 %。结论 Ho :YAG激光治疗膀胱肿瘤简单易行 ,无并发症。在治疗输尿管口肿瘤及常规电切镜不易达到的肿瘤具有优势 。

Objectives To review our initial experience with the Ho:YAG laser in treating superficial bladder tumors.Methods Ho:YAG laser was applied for treating 52 cases of bladder tumors which were confirmed by cystoscopy and pathology with totally 87 tumors.All tumors were in stage Ta～T 2 and tumors grade G1～G2.The optical fiber was put into bladder through cystoscopy.Ho:YAG laser was used endoscpically to cut and vaporize bladder tumor and normal bladder mucosa near the tumor.Results Nine of 52 patients were performed under local anesthesia in outpatient.Operation time was apparently short (mean 25 minutes) Histopathology of biopsies showed no cancer cells left.There were no intraoperative complication such as bleeding,perforation and delay complication.Catheter time is very short,about 1～3 days or without catheter at all.None of the ureteral orifice were damaged in seven cases of bladder tumors near the ureteral orifice.Six patients were recrred during our follow-up in 50 patients (12%).Conclusions It has been demonstrated that Ho:YAG laser therapy is provided with advantages of simple procedure,the absence of complication,high patient satisfaction,and ability to be used in the outpatient.It is more convenience than TUR-Bt in tumors in the neck of bladder or apex of bladder.