等离子针状电极在经尿道近输尿管口膀胱肿瘤切除术中的临床应用(附16例报道)

Clinical application of the needle electrode in transurethral plasmakinetic resection of bladder tumor around ureteral orifice:A report of 16 cases

目的:探讨等离子针状电极在经尿道近输尿管口膀胱肿瘤切除术中的应用价值。方法:回顾性分析北京大学国际医院泌尿外科2015年6月至2019年12月期间收治的16例接受经尿道等离子针状电极切除的近输尿管口膀胱肿瘤患者的临床资料。肿瘤基底部距离输尿管口1 cm以内者7例,其中侵犯输尿管口者2例,距输尿管口1~2 cm者9例。全部研究对象术前均明确诊断并除外手术禁忌,采用等离子针状电极对肿瘤进行整块切除,将全部切除组织送病理检查,术后行规律灌注治疗并随访。对手术时间、闭孔神经反射发生率、出血量、输尿管导管或双猪尾管留置情况、术后肾积水发生率、肿瘤临床分期、复发率等进行统计分析。结果:16例患者均顺利完成手术,手术时间16~57 min,平均(32.6±11.8)min,所有患者均未发生明显闭孔神经反射及围手术期出血。术中肿瘤切除前需要预置输尿管导管7例,术后继续留置输尿管导管4例,更换留置双猪尾管3例。术后病理提示所有肿瘤均为尿路上皮癌,其中低级别9例、高级别7例;病理分期:Ta期10例、T1期5例、T2a期1例,所有肿瘤基底部及侧切缘均为阴性。所有患者接受3~56个月的随访,平均(26.0±18.1)个月,无1例出现上尿路积水和肿瘤复发。结论:经尿道等离子针状电极可以整块切除膀胱肿瘤,减少闭孔神经反射并有效保护输尿管口结构,是一种治疗近输尿管口膀胱肿瘤安全、有效的手术方式。

Objective:To explore the clinical application value of using needle electrode in transurethral plasmakinetic resection of bladder tumor around ureteral orifice.Methods:Retrospective analysis was performed on the clinical data of 16 cases who had bladder tumors around ureteral orifice and underwent transurethral resection using plasmakinetic needle electrode in Department of Urology,Peking University International Hospital from June 2015 to December 2019.There were nine cases with the tumor of one to two centimeters from the ureteral orifice.The rest of the seven cases had tumor that was within one centimeter from the ureteral orifice,including two cases whose ureteral orifice was invaded by the tumor.All the patients studied were diagnosed before surgery and contraindications were excluded.The plasmakinetic needle electrode was used to treat the tumor with en bloc resection,and all the excised tissue was sent for pathological examination.Intravesical chemotherapy and postoperative follow-ups were performed.Statistical analysis was performed on the operation time,the incidence of obturator nerve reflex,the peri-operative bleeding,the parameters of indwelling ureteral catheter or double-J stent,the incidence of postoperative hydronephrosis,the clinical stage of tumor,and the recurrence rate.Results:The operation was successfully completed for all the sixteen cases.The operation time was 16 to 57 minutes,with an average of(32.6±11.8)minutes.No obvious obturator nerve reflex and perioperative bleeding occurred in all the patients.Ureteral catheters were indwelled prior to the operation of tumor resection in seven cases.Four of the seven cases had the ureteral catheters remained while the rest three were replaced by double-J stent after surgery.Postoperative pathological analysis showed that all the tumors were urothelial carcinoma,including 9 cases of low grade and 7 cases of high grade.Pathological staging:10 cases were in Ta stage,5 cases in T1 stage,and 1 case in T2a stage.All tumor bases and lateral margins were negative.All the patients received 3-56 months,with an average of(26.0±18.1)months of follow-up.There was no case of upper urinary tract hydronephrosis or tumor recurrence.Conclusion:The transurethral plasmakinetic resection of bladder tumor using needle electrode can realize en bloc tumor resection without obturator nerve reflex and reduce the risk of ureteral orifice injury.It is a safe and effective surgical method for treating bladder tumors around the ureteral orifice.