膀胱肿瘤内镜黏膜下剥离术治疗非肌层浸润性膀胱癌的疗效分析

Analysis on the curative efficacy of bladder tumor endoscopic submucosal dissection in the treatment of non-muscle invasive bladder cancer

目的探讨非肌层浸润性膀胱癌患者采用膀胱肿瘤内镜黏膜下剥离术(BT-ESD)治疗的临床效果。方法将62例非肌层浸润性膀胱癌患者随机分为经尿道膀胱肿瘤切除术(TURBT)组、经尿道钬激光膀胱肿瘤切除术(HOLRBT)组和BT-ESD组,观察并比较3组的手术情况及治疗效果。结果3组患者手术均成功,BT-ESD组的术中出血量显著少于TURBT组与HOLRBT组(P<0.05),尿管留置时间、术后住院时间显著短于TURBT组与HOLRBT组(P<0.05);TURBT组发生13例闭孔神经反射、2例膀胱穿孔,HOLRBT组发生1例膀胱穿孔,BT-ESD组发生3例闭孔神经反射,BT-ESD组的并发症发生率显著低于TURBT组(P<0.05);BT-ESD组肿瘤分期均准确,且患者术后复发率及原位复发率均显著低于TURBT组(P<0.05)。结论采用BT-ESD治疗浅表性膀胱肿瘤患者,创伤小,安全性高,患者痛苦少,肿瘤切除完整,肿瘤分期准确,复发率低,疗效确切。

Objective To investigate the clinical efficacy of bladder tumor endoscopic submucosal dissection(BT-ESD)in the treatment of non-muscle invasive bladder cancer.Methods A total of 62 patients with non-muscle-invasive bladder cancer were randomly divided into three treatment groups:transurethral resection of bladder tumor(TURBT)group,transurethral holmium laser resection of bladder tumor(HOLRBT)group,and BT-ESD.The surgical conditions and curative effects of three groups were observed.Results All three groups successfully completed the operations.Perioperative bleeding amount during surgery in the BT-ESD group was significanlly less,indwelling time and postoperative hospital stay were significantly shorter than the other two groups(P<0.05).Obturator nerve reflex occurred in 13 cases in the TURBT group,and 3 cases in the BT-ESD group,bladder perforation in 2 cases in the TURBT group,and 1 case in HOLRBT group.The incidence of complications in the BT-ESD group was significantly lower than that in the TURBT group(P<0.05).The patients in the BT-ESD group had accurate tumor staging,and their postoperative and in situ recurrence rate were significantly lower than those in the TURBT group(P<0.05).Conclusion BT-ESD has less trauma,higher safety,less pain,complete tumor resection,accurate tumor staging,and lower recurrence rate in the treatment of superficial bladder tumors.